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Ankylosing Spondylitis — RACP Adult Medicine MCQ

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ModerateRheumatologyAnkylosing SpondylitisRACP Adult Medicine

A 35-year-old man presents with acute low back pain and bilateral sacroiliitis on MRI. He has a history of recurrent anterior uveitis. HLA-B27 is positive. CRP is 55 mg/L. NSAIDs provide inadequate relief after 3 months. What is the most appropriate next treatment?

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Correct answer: B — Adalimumab

For axial spondyloarthritis (including ankylosing spondylitis) with inadequate response to ≥2 NSAIDs, biologic therapy with a TNF inhibitor (adalimumab, infliximab, etanercept) or IL-17 inhibitor (secukinumab) is recommended. Conventional DMARDs (methotrexate, sulfasalazine, leflunomide) are NOT effective for axial disease, only for peripheral arthritis. Adalimumab is PBS-listed for this indication.

Reference: eTG – 2025 – Rheumatology; ASAS/EULAR – 2022 – axSpA Management Recommendations