QuestionSBA
QuestionChoice
It has been stated that NSAIDs have not been successful in managing this patient's symptoms. Paracetamol is at the bottom of the pain ladder, so it alone would not be appropriate in this case.
10001334
d
Paracetamol
QuestionChoice
Disease-modifying anti-rheumatic drugs (DMARDs) are most useful in the treatment of ankylosing spondylitis with enthesitis and do not improve spinal inflammation. This patient is suffering from spinal inflammation and extra-articular involvement, therefore this is not the most appropriate next step.
10001335
e
Methotrexate
QuestionChoice
NICE guidance suggests that TNF–alpha inhibitors should be used in cases of ankylosing spondylitis where NSAID treatment has failed. They should also be used in severe cases as demonstrated in this patient who has anterior uveitis (a complication of ankylosing spondylitis).
10001331
a
Etanercept
QuestionChoice
Oral steroids are not indicated in the treatment of ankylosing spondylitis; steroids must be given intra-articularly in ankylosing spondylitis.
10001333
c
Oral prednisolone
QuestionChoice
Physiotherapy is indicated in ankylosing spondylitis for improving and maintaining posture, flexibility and mobility. However, physiotherapy alone would not be enough for this patient with extra-articular involvement who has experienced no relief from NSAID therapy.
10001336
f
Physiotherapy
Concept
Chapter
2693
3911
ankylosing spondylitis
Topic
146
Rheumatology
12813
A 21-year-old male presents to clinic following a 5-month history of early morning back pain and stiffness that improves with activity. The patient also complains of an acutely red eye and sensitivity to light that has developed over 2 weeks.

On examination, there is a limited range of lumbar motion.

The patient was recently diagnosed with ankylosing spondylitis and has received NSAID treatment which has been unsuccessful in managing his symptoms.

What is the next most appropriate step in treatment?
a