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Axial spondyloarthritis investigation — SCE Rheumatology MCQ

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EasySpondyloarthropathiesAxial spondyloarthritis investigationSCE Rheumatology

A 25-year-old woman has inflammatory back pain for 9 months. Pelvic radiograph is normal and HLA-B27 is negative. CRP is 18 mg/L and examination shows reduced lumbar flexion. She has a history of acute anterior uveitis. Symptoms persist despite physiotherapy. What is the most appropriate investigation?

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Correct answer: C — MRI sacroiliac joints

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

MRI sacroiliac joints is best because MRI sacroiliac joints can show active sacroiliitis when radiographs and HLA-B27 are negative. A is less suitable because RF titre does not evaluate axial SpA; B is less suitable because lumbar radiographs alone miss early sacroiliac inflammation; D is less suitable because repeating HLA-B27 is not useful because genotype does not change; E is less suitable because DEXA assesses bone density rather than inflammatory sacroiliitis. Clinical pearl: NICE emphasises that axial SpA can occur in women and in HLA-B27-negative patients.

Reference: NICE NG65