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Axial spondyloarthritis — SCE Rheumatology MCQ

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HardSpondyloarthropathiesAxial spondyloarthritisSCE Rheumatology

A 31-year-old has inflammatory back pain, normal sacroiliac radiographs and a negative HLA-B27 test. CRP is normal but clinical suspicion of axial spondyloarthritis remains high. What is the next imaging step?

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Correct answer: A — Unenhanced MRI using STIR and T1 inflammatory-back-pain sequences

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

A is correct. NICE recommends unenhanced MRI with STIR and T1 sequences of the whole spine and sacroiliac joints when radiographs do not meet modified New York criteria. Normal CRP and negative HLA-B27 do not exclude axial SpA. Scintigraphy is not recommended, lumbar CT omits sacroiliac inflammatory change, and delaying assessment risks diagnostic harm.

Reference: NICE NG65: spondyloarthritis diagnosis and management. https://www.nice.org.uk/guidance/ng65/chapter/Recommendations