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Axial spondyloarthritis after TNF failure — SCE Rheumatology MCQ

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HardSpondyloarthropathiesAxial spondyloarthritis after TNF failureSCE Rheumatology

A 44-year-old man has active radiographic axial spondyloarthritis after inadequate response to a TNF inhibitor. Examination shows limited spinal movement and enthesitis. Investigations show infection screening is negative. What is the most appropriate biologic?

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Correct answer: D — Ixekizumab

IL-17 inhibition such as ixekizumab is a reasonable alternative pathway after TNF inhibitor failure in axial disease. Belimumab and rituximab are not axial spondyloarthritis biologics. Response criteria should be assessed objectively after starting targeted therapy.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/musculoskeletal-conditions