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Axial spondyloarthritis — SCE Rheumatology MCQ

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EasySpondyloarthropathiesAxial spondyloarthritisSCE Rheumatology

A 24-year-old woman has low back pain starting before age 40, worse at night and better with exercise. Examination shows spinal flexion is reduced and sacroiliac stress tests are painful. Investigations show CRP is raised and pelvic radiograph is normal. The admitting team asks which diagnosis best explains the whole presentation. What is the most likely diagnosis?

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Correct answer: A — Axial spondyloarthritis

Axial spondyloarthritis is the best answer because the pattern described is most consistent with Axial spondyloarthritis, including the distribution of symptoms and the targeted investigation results. Leflunomide hepatotoxicity is a plausible distractor, but it does not account for the key discriminator in the stem. Reactive arthritis and Granulomatosis with polyangiitis would be more appropriate in a different clinical pattern or at another point in the pathway, while Enteropathic arthritis is suboptimal for this presentation. Clinical pearl: in SCE-style questions, the decisive clue is usually the pattern across joints, extra-articular features and targeted immunology rather than a single antibody result.

Reference: NICE NG65; EULAR/ASAS axial spondyloarthritis recommendations; BNF