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Ankylosing spondylitis — MCCQE Part 1 MCQ

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ModerateBack PainAnkylosing spondylitisMCCQE Part 1

A 25-year-old man has inflammatory low back pain (morning stiffness >1h, improves with exercise), alternating buttock pain. HLA-B27+, bilateral sacroiliitis on XR. Most appropriate initial treatment?

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Correct answer: B — NSAIDs (naproxen or indomethacin) first-line

Ankylosing spondylitis: NSAIDs first-line. Methotrexate NOT effective for axial disease. Biologics for failure of >=2 NSAIDs over 4 weeks. Physiotherapy essential.

Reference: CRA SpA Recommendations