Axial spondyloarthritis fracture — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

HardSpondyloarthropathiesAxial spondyloarthritis fractureSCE Rheumatology

A 61-year-old man with ankylosing spondylitis and a rigid kyphotic spine falls from standing height. He develops severe thoracic pain and mild paraesthesia in both feet. Plain radiographs are difficult to interpret because of syndesmophytes. Neurological examination is evolving. What is the most important complication to screen for?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Unstable spinal fracture

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

Unstable spinal fracture is best because ankylosed spines fracture after minor trauma and may be unstable with neurological compromise. A is less suitable because trochanteric bursitis causes lateral hip pain rather than thoracic pain; C is less suitable because fibromyalgia does not cause focal post-traumatic neurological signs; D is less suitable because costochondritis would not cause paraesthesia; E is less suitable because disc prolapse alone does not explain severe pain in a rigid ankylosed spine after trauma. Clinical pearl: patients with axial SpA should seek urgent assessment after falls because fractures can be occult.

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