4 board-style questions on ankylosing spondylitis in the PulseMD family medicine question bank — physician-reviewed, written against current guidelines with the reference cited on each question. Two free samples below; the full set with answers, explanations, and spaced review is free to start.
A 26-year-old man presents with low back pain and stiffness that has been worsening over the past 8 months. The pain is worse in the morning (stiffness lasting over 60 minutes) and improves with exercise but not with rest. He has noticed bilateral buttock pain that alternates sides. He also reports right heel pain (Achilles tendon area) and a recent episode of right eye redness and pain diagnosed as anterior uveitis. On examination, he has limited lumbar flexion (modified Schober test: 3 cm expansion, normal >5 cm) and restricted chest expansion (2 cm, normal >5 cm). Bilateral sacroiliac joint tenderness is present. Labs show HLA-B27 positive, ESR 44 mm/hr, CRP 3.2 mg/dL, and negative RF. Pelvic X-ray shows bilateral sacroiliitis with sclerosis and erosions. What is the most appropriate initial treatment?
A 30-year-old man with ankylosing spondylitis confirmed by MRI sacroiliitis has persistent inflammatory back pain and morning stiffness despite a 3-month trial of two different NSAIDs at maximum doses. His BASDAI score is 5.2 (active disease). He has no peripheral arthritis. Which of the following is the MOST appropriate next step in pharmacologic management?
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