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Radiographic axial spondyloarthritis — SCE Rheumatology MCQ

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HardSpondyloarthropathiesRadiographic axial spondyloarthritisSCE Rheumatology

A 31-year-old woman has longstanding inflammatory back pain, reduced spinal mobility, bilateral grade 3 sacroiliitis and thin vertical syndesmophytes. What is the most appropriate biologic?

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Correct answer: D — Ixekizumab

Ixekizumab is the single best answer because definite radiographic sacroiliitis with syndesmophytes indicates radiographic axial spondyloarthritis. The stem is testing biologic selection, not isolated recall, so the relevant clinical pattern and risk context determine the answer. Mechanical back pain is less suitable because it fits a different clinical pattern or a different treatment threshold; Rheumatoid arthritis, Methotrexate for isolated axial symptoms and Rituximab do not address the key discriminator in this vignette. Clinical pearl: in SCE-style rheumatology questions, autoantibodies, imaging and synovial fluid findings should be interpreted with the whole phenotype.

Reference: NICE NG65; BSR psoriatic arthritis and axial spondyloarthritis guidance