Anti-TNF Radiographic Progression AS — SCE Rheumatology MCQ

Correct answer: C — TNF inhibition may modestly slow structural progression after sustained exposure, with a delayed effect not reliably demonstrated in short-term studies.

Explanation lettering: D = shown as A · E = shown as B · B = shown as D · A = shown as E

TNF inhibitors clearly improve disease activity, symptoms and function. Their structural effect is less immediate: early 2-year comparisons did not consistently demonstrate inhibition of mSASSS progression, whereas longer-term cohorts and meta-analyses support a modest, time-shifted reduction that may become detectable after approximately 2–4 years of sustained exposure. They do not abolish syndesmophyte formation, and absence of progression in one patient cannot establish causality. Therefore C is the best interpretation. B ignores accumulating long-term evidence, while A and E make unsupported absolute claims. D is incorrect because the 2-year SURPASS head-to-head trial found no significant radiographic advantage of secukinumab over adalimumab biosimilar.

Reference: Ramiro S et al. Treatment with tumour necrosis factor inhibitors is associated with a time-shifted retardation of radiographic spinal progression in patients with axial spondyloarthritis. Annals of the Rheumatic Diseases, 2022. https://pubmed.ncbi.nlm.nih.gov/32419337/