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Peripheral spondyloarthritis — SCE Rheumatology MCQ

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EasySpondyloarthropathiesPeripheral spondyloarthritisSCE Rheumatology

A 74-year-old woman has asymmetric knee and ankle arthritis with heel enthesitis. Examination shows spinal movement is preserved. Investigations show RF and anti-CCP are negative. 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: B — Sulfasalazine

Sulfasalazine is the best answer because sulfasalazine is the most appropriate next step for peripheral spondyloarthritis in this clinical setting. Therapeutic exercise is a plausible distractor, but it does not account for the key discriminator in the stem. NSAID therapy and physiotherapy and Hydroxychloroquine would be more appropriate in a different clinical pattern or at another point in the pathway, while Urgent antibiotics 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