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Axial spondyloarthritis — SCE Rheumatology MCQ

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EasySpondyloarthropathiesAxial spondyloarthritisSCE Rheumatology

A 36-year-old man 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 investigation?

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Correct answer: BMRI of the sacroiliac joints

MRI of the sacroiliac joints is the single best answer because young-onset inflammatory back pain plus MRI sacroiliitis indicates axial spondyloarthritis. The stem is testing investigation 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