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Axial spondyloarthritis — SCE Rheumatology MCQ

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ModerateSpondyloarthropathiesAxial spondyloarthritisSCE Rheumatology

A 62-year-old woman has inflammatory back pain starting at 24, alternating buttock pain, raised CRP and MRI bone marrow oedema at both sacroiliac joints. What is the most appropriate management?

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Correct answer: B — NSAID treatment and exercise

Start regular NSAID therapy and physiotherapy is the single best answer because young-onset inflammatory back pain plus MRI sacroiliitis indicates axial spondyloarthritis. The stem is testing management choice, 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: https://www.nice.org.uk/guidance/conditions-and-diseases/musculoskeletal-conditions