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Non-radiographic axial spondyloarthritis — SCE Rheumatology MCQ

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EasySpondyloarthropathiesNon-radiographic axial spondyloarthritisSCE Rheumatology

A 27-year-old man has inflammatory back pain for two years, alternating buttock pain and morning stiffness improving with exercise. HLA-B27 is positive, CRP is 18 mg/L and pelvic radiograph is normal. MRI shows bilateral active sacroiliitis. What is the most likely diagnosis?

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Correct answer: C — Non-radiographic axial spondyloarthritis

Inflammatory back pain, HLA-B27 positivity, raised CRP and MRI sacroiliitis with normal radiographs support non-radiographic axial spondyloarthritis. Mechanical pain would not cause MRI inflammatory sacroiliitis. The distinction from radiographic disease depends on plain radiographic sacroiliitis.

Reference: NICE NG65; ASAS-EULAR axial spondyloarthritis recommendations