Spondyloarthritis

Question · easy

A 28-year-old man reports 8 months of low back and alternating buttock pain that is worst in the second half of the night and improves after he gets up and moves around. Morning stiffness lasts about an hour. He has no peripheral joint symptoms. Plain radiographs of the pelvis and sacroiliac joints are normal. ESR and C-reactive protein are normal. Which of the following is the most appropriate next diagnostic step?

Reassurance and a muscle relaxant CT of the lumbar spine Immediate trial of a TNF inhibitor MRI of the sacroiliac joints

Question · easy

A 33-year-old woman with established ankylosing spondylitis calls because her right eye became acutely red, painful, and photophobic overnight. Which of the following is the most likely diagnosis?

Posterior uveitis Bacterial conjunctivitis Acute angle-closure glaucoma Acute anterior uveitis

Question · medium

A 36-year-old man with ankylosing spondylitis and Crohn disease has persistent axial disease activity despite 6 weeks of continuous full-dose naproxen. Which of the following is the most appropriate biologic to initiate?

Etanercept Tofacitinib Infliximab Secukinumab

Question · medium

A 47-year-old woman with a 10-year history of plaque psoriasis reports progressive pain and swelling of the distal interphalangeal joints of both hands and a diffusely swollen right third toe. Nail pitting is present. Rheumatoid factor is negative. Which of the following radiographic findings would be most specific for her likely diagnosis?

Asymmetric joint-space narrowing with subchondral sclerosis and osteophytes Marginal erosions with juxta-articular new bone formation and pencil-in-cup deformity Chondrocalcinosis of the triangular fibrocartilage Periarticular osteopenia with marginal erosions

Question · hard

A 26-year-old man develops acute asymmetric swelling of the left knee and right ankle with severe heel pain, 3 weeks after a febrile diarrheal illness. He also reports dysuria. Synovial fluid from the knee shows 48,000 leukocytes/μL with neutrophil predominance; Gram stain and cultures are negative. Which of the following statements about management is correct?

Systemic glucocorticoids are the preferred initial treatment A 6-week course of antibiotics is required to eradicate the joint inflammation NSAIDs are first-line therapy; antibiotics are not routinely warranted for enteric reactive arthritis A TNF inhibitor should be started immediately as first-line therapy