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IBD-associated arthritis — SCE Rheumatology MCQ

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HardSpondyloarthropathiesIBD-associated arthritisSCE Rheumatology

A 36-year-old woman with ulcerative colitis has inflammatory back pain and alternating buttock pain. Examination shows spinal flexion is reduced but peripheral joints are quiet. Investigations show CRP is raised during a bowel flare. What is the most appropriate investigation?

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Correct answer: B — MRI spine and sacroiliac joints

The best answer is “MRI spine and sacroiliac joints”. MRI spine and sacroiliac joints most directly resolves the diagnostic or staging uncertainty at this point in the pathway; the other investigations answer different questions or have lower yield. The remaining choices—“Plain shoulder radiograph, within a rheumatology pathway”, “Colonoscopy as the arthritis test”, “Serum calcium, after specialist assessment”, “Anti-CCP antibody, with clinical reassessment”—are credible in related rheumatology presentations, but each addresses a different diagnosis, investigation, treatment sequence or complication and does not fit the decisive findings in this stem.

Reference: NICE NG65 spondyloarthritis: https://www.nice.org.uk/guidance/ng65/chapter/Recommendations