Axial spondyloarthritis and IBD — SCE Rheumatology MCQ

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HardSpondyloarthropathiesAxial spondyloarthritis and IBDSCE Rheumatology

A 42-year-old man has active axial spondyloarthritis despite two NSAIDs. He also has Crohn's disease with recent ileocolonic ulceration. BASDAI is 6.1 and MRI shows active sacroiliitis. There is no infection and screening for TB and hepatitis is negative. What is the most appropriate biologic?

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Correct answer: B — Adalimumab

Explanation lettering: C = shown as A · E = shown as B · A = shown as C · B = shown as E

Adalimumab is best because adalimumab can treat axial spondyloarthritis and Crohn's disease, making it preferable where active IBD coexists. A is less suitable because etanercept is less effective for inflammatory bowel disease; B is less suitable because anakinra is not an axial spondyloarthritis treatment; C is less suitable because tocilizumab is not used for axial disease and may mask inflammatory markers; D is less suitable because secukinumab can worsen or unmask IBD in some patients. Clinical pearl: extra-articular disease can decide biologic choice in spondyloarthritis.

Reference: NICE NG65; ASAS-EULAR axial spondyloarthritis recommendations 2022