Axial spondyloarthritis with Crohn's disease — SCE Rheumatology MCQ

Correct answer: A — Refer for biologic therapy assessment with gastroenterology input

Refer for biologic therapy assessment with gastroenterology input is the single best answer because associated Crohn's disease influences biologic selection. 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: NICE NG65; BSR psoriatic arthritis and axial spondyloarthritis guidance