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Axial spondyloarthritis — SCE Rheumatology MCQ

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ModerateSpondyloarthropathiesAxial spondyloarthritisSCE Rheumatology

A 33-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: D — HLA-B27 testing

HLA-B27 testing is the best answer because hla-b27 testing is the investigation most likely to resolve the immediate diagnostic or monitoring question in axial spondyloarthritis. Synovial fluid culture is a plausible distractor, but it does not account for the key discriminator in the stem. Plain radiograph and Plain radiographs of hands would be more appropriate in a different clinical pattern or at another point in the pathway, while MRI sacroiliac joints is suboptimal for this presentation. Clinical pearl: autoantibodies are supportive tests and should be interpreted alongside phenotype, inflammatory markers, urinalysis and imaging.

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