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Axial spondyloarthritis — SCE Rheumatology MCQ

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EasySpondyloarthropathiesAxial spondyloarthritisSCE Rheumatology

A 52-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 diagnosis is established and symptoms remain clinically important despite initial supportive measures. There is no contraindication to disease-modifying or anti-inflammatory escalation. What is the most appropriate management?

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Correct answer: D — NSAID therapy and physiotherapy

NSAID therapy and physiotherapy is the best answer because nsaid therapy and physiotherapy is the most appropriate next step for axial spondyloarthritis in this clinical setting. Local corticosteroid injection is a plausible distractor, but it does not account for the key discriminator in the stem. Oral prednisolone and Increase NSAID therapy would be more appropriate in a different clinical pattern or at another point in the pathway, while Treat underlying infection is suboptimal for this presentation. Clinical pearl: rheumatology management is generally treat-to-target, but infection risk, pregnancy plans and shared-care monitoring often determine the safest answer.

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