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IBD-associated spondyloarthritis — SCE Rheumatology MCQ

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ModerateSpondyloarthropathiesIBD-associated spondyloarthritisSCE Rheumatology

A 78-year-old man has ulcerative colitis with flares of knee and ankle synovitis that parallel bowel activity and mild sacroiliitis. What is the most likely diagnosis?

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Correct answer: B — IBD-associated spondyloarthritis

IBD-associated spondyloarthritis is the single best answer because peripheral arthritis linked to inflammatory bowel disease is enteropathic spondyloarthritis. The stem is testing diagnostic synthesis, 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