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Axial spondyloarthritis — SCE Rheumatology MCQ

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EasySpondyloarthropathiesAxial spondyloarthritisSCE Rheumatology

A 31-year-old woman is diagnosed with axial spondyloarthritis. BASDAI is 5.2 and spinal pain VAS is 6 cm. She has no peptic ulcer disease, renal impairment or cardiovascular contraindication. She has not previously taken regular anti-inflammatory therapy. What is the most appropriate management?

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

Reveal the answer and explanation

Correct answer: D — Start a regular NSAID with gastroprotection if indicated

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

Start a regular NSAID with gastroprotection if indicated is best because NSAIDs are first-line pharmacological treatment for pain and stiffness in axial spondyloarthritis when safe. A is less suitable because methotrexate does not treat axial disease effectively; C is less suitable because reassurance alone is inadequate with active disease; D is less suitable because opioids do not address inflammation and are not first-line; E is less suitable because rituximab is not an axial spondyloarthritis biologic. Clinical pearl: structured exercise and NSAIDs are the initial platform before biologic eligibility is assessed.

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