Spine: biologic therapy in ankylosing spondylitis: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Spine: biologic therapy in ankylosing spondylitis

Sample item

A 28-year-old man with axial ankylosing spondylitis still has high disease activity after taking two different NSAIDs at full dose for a total of four weeks. Which treatment should be added?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. A tumour necrosis factor inhibitor

NSAIDs and exercise are first-line in axial disease. If control remains inadequate after two NSAIDs, a TNF inhibitor or an IL-17 inhibitor is the next step. Conventional DMARDs such as sulfasalazine help peripheral arthritis only, and long-term oral steroids are not recommended.

Option by option

  • A. A tumour necrosis factor inhibitor (correct)

    Correct. Failure of two NSAIDs in active axial disease warrants a TNF inhibitor.

  • B. Long-term oral prednisolone

    Long-term oral steroids carry toxicity and have no proven benefit in axial disease.

  • C. Oral methotrexate

    Methotrexate has not shown benefit for axial disease.

  • D. Sulfasalazine for axial disease

    Sulfasalazine is effective for peripheral joint involvement but not for the axial skeleton.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is A, A tumour necrosis factor inhibitor. NSAIDs and exercise are first-line in axial disease.

Why is "Long-term oral prednisolone" not the answer?

Long-term oral steroids carry toxicity and have no proven benefit in axial disease.

Why is "Oral methotrexate" not the answer?

Methotrexate has not shown benefit for axial disease.

Why is "Sulfasalazine for axial disease" not the answer?

Sulfasalazine is effective for peripheral joint involvement but not for the axial skeleton.

What concept does this question test?

It tests Spine: biologic therapy in ankylosing spondylitis in Orthopaedics. If control remains inadequate after two NSAIDs, a TNF inhibitor or an IL-17 inhibitor is the next step. Conventional DMARDs such as sulfasalazine help peripheral arthritis only, and long-term oral steroids are not recommended.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Spine: biologic therapy in ankylosing spondylitis?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.