Axial spondyloarthritis biologic therapy — SCE Rheumatology MCQ

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ModerateSpondyloarthropathiesAxial spondyloarthritis biologic therapySCE Rheumatology

A 35-year-old man has radiographic axial spondyloarthritis with BASDAI 6.8 and spinal pain VAS 7 cm. He has tried two NSAIDs at maximal tolerated doses without adequate response. MRI shows active sacroiliitis and CRP remains elevated. TB and hepatitis screening are negative. What is the most appropriate biologic?

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Correct answer: E — Adalimumab

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

Adalimumab is best because a TNF inhibitor such as adalimumab is an appropriate biologic option for active axial spondyloarthritis after inadequate NSAID response and objective inflammation. A is less suitable because belimumab is an SLE drug; B is less suitable because methotrexate is not effective for axial symptoms; C is less suitable because cyclophosphamide is not used for routine axial disease; E is less suitable because rituximab is not used for axial spondyloarthritis. Clinical pearl: NICE biologic pathways require active disease scores and inadequate NSAID response.

Reference: NICE NG65; NICE TA383