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Axial spondyloarthritis — SCE Rheumatology MCQ

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HardSpondyloarthropathiesAxial spondyloarthritisSCE Rheumatology

A patient has ASDAS 2.8 despite exercise therapy and adequate trials of two NSAIDs. Sacroiliac radiographs are normal, but CRP is raised and MRI shows active sacroiliitis. Which principle governs escalation to targeted therapy?

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Correct answer: D — Objective inflammation permits escalation despite absent radiographic sacroiliitis

The treatment pathway includes non-radiographic axial spondyloarthritis when a rheumatologist verifies active disease and objective inflammation through raised CRP or MRI. Persistent high activity despite appropriate non-pharmacological care and NSAIDs can therefore justify targeted-therapy assessment without waiting for radiographic damage.

Reference: NICE NG65: spondyloarthritis in over 16s — recommendations (Updated June 2017): https://www.nice.org.uk/guidance/ng65/chapter/Recommendations; 2025 BSR guideline for axial spondyloarthritis with biologic and targeted synthetic DMARDs (Published April 2025): https://academic.oup.com/rheumatology/article/64/6/3242/8108015