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Anti-Mi-2 Phenotype — SCE Rheumatology MCQ

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HardMyositisAnti-Mi-2 PhenotypeSCE Rheumatology

A patient with axial spondyloarthritis has recurrent anterior uveitis requiring repeated topical glucocorticoids despite otherwise similar access to several advanced therapies. Which mechanism is preferred by BSR 2025?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — A monoclonal TNF inhibitor chosen collaboratively with the ophthalmology service

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

C is correct. For moderate-to-severe or recurrent uveitis, BSR prefers a monoclonal TNF inhibitor over other mechanisms and recommends a rheumatology–ophthalmology decision. Monoclonal agents have better evidence for preventing ocular relapse than etanercept, whose soluble-receptor biology does not confer the same benefit. Axial efficacy alone is therefore insufficient for selection. The answer is a mechanism preference rather than an assertion that every monoclonal TNF inhibitor is interchangeable for all comorbidity and safety contexts.

Reference: BSR 2025 axial-spondyloarthritis biologic and targeted-DMARD guideline: https://academic.oup.com/rheumatology/article/64/6/3234/8108017