QuestionSBA
QuestionChoice
This should be an adjunct to medical treatment, however, due to the severity of symptoms and spinal appearance, medical management is required.
10034993
b
Advise physiotherapy
QuestionChoice
This is correct. The history of lower back pain with bamboo spine appearance on x-ray suggests ankylosing spondylitis with possible HLA B27 associated complications such as inflammatory bowel and uveitis. NSAIDs are first-line medical management, after which anti-TNF agents are used.
10034992
a
Infliximab
QuestionChoice
This is not appropriate given the symptoms and concerning appearance on imaging.
10034995
d
Discharge with reassurance
QuestionChoice
Surgery may occasionally be required for severe joint deformity later down the line whereas medical management is the initial priority here.
10034994
c
Advise surgical correction
QuestionChoice
This is a JAK inhibitor which is an option later down the line as it is extremely expensive and reserved for recalcitrant cases.
10034996
e
Upadacitinib
QuestionComment
as a gp i would be referring
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Kussmaul Sign
Concept
Chapter
2693
6116
Ankylosing spondylitis
Topic
334
Clinical Imaging
19402
Infliximab, a TNF-alpha inhibitor, is commonly used as a second-line treatment for ankylosing spondylitis when NSAIDs and physical therapy are insufficient, helping reduce inflammation, pain, and improve mobility.
Picture
https://en.m.wikipedia.org/wiki/File:Bamboo_spine_ankylosing_spondylitis.jpg
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images/xm32j8qd1705486621116.jpg
images/xm32j8qd1705486621116_256.jpg
images/xm32j8qd1705486621116_512.jpg
FggGBAAHKGe3x5emh4cAAAAAAA==
Topic
334
Clinical Imaging
A 32-year-old man comes to the GP due to longstanding lower back pain which has proved resistant to exercise and non-steroidal analgesia. He describes multiple episodes of diarrhoea and blurred vision in the past. He is referred to specialists and imaging investigations are performed.

A spine X-ray shows:

[lightgallery]

Which of the following is the most appropriate management given the likely diagnosis?
a