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Axial spondyloarthritis — SCE Rheumatology MCQ

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ModerateMusculoskeletal investigationsAxial spondyloarthritisSCE Rheumatology

A 69-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 consultant wants the next test most likely to confirm the suspected process or guide treatment. The result will change diagnosis, staging or immediate treatment. What is the most appropriate investigation?

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Correct answer: A — MRI sacroiliac joints

MRI sacroiliac joints is the best answer because mri sacroiliac joints is the investigation most likely to resolve the immediate diagnostic or monitoring question in axial spondyloarthritis. Urinalysis is a plausible distractor, but it does not account for the key discriminator in the stem. Plain radiograph and ENA profile would be more appropriate in a different clinical pattern or at another point in the pathway, while CRP and ESR is suboptimal for this presentation. Clinical pearl: autoantibodies are supportive tests and should be interpreted alongside phenotype, inflammatory markers, urinalysis and imaging.

Reference: BSR hot swollen joint guideline; NICE NG100; EULAR imaging recommendations