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Ankylosing spondylitis treatment escalation — SCE Rheumatology MCQ

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ModerateSpondyloarthropathiesAnkylosing spondylitis treatment escalationSCE Rheumatology

A 29-year-old woman with ankylosing spondylitis has persistent BASDAI 6.4 despite naproxen and etoricoxib trials. Spinal pain VAS is 7 cm, CRP is raised and MRI shows active sacroiliitis. She has no psoriasis, IBD or uveitis. What is the most appropriate next management?

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Correct answer: C — Refer for biologic or targeted synthetic DMARD assessment

Active axial SpA despite adequate NSAID trials and objective inflammation should prompt assessment for targeted therapy according to NICE/BSR pathways. Methotrexate is not effective for axial disease, though it may have a role in peripheral arthritis. Long-term systemic steroids are not a disease-modifying strategy for axial SpA.

Reference: NICE NG65; BSR axial spondyloarthritis biologic guideline 2025