A 45-year-old man presents with chronic lower back pain for 3 years that is worse at rest, improves with activity, and is associated with morning stiffness lasting over 1 hour. He has limited lumbar flexion. X-ray of the pelvis shows bilateral sacroiliitis with syndesmophyte formation. HLA-B27 is positive. What is the most appropriate initial pharmacotherapy for axial disease control?

• A Allopurinol
• B Sulfasalazine
• C Methotrexate
• D Continuous high-dose NSAIDs ✓

Explanation

Ankylosing spondylitis is confirmed by bilateral sacroiliitis, inflammatory back pain, and HLA-B27 positivity. First-line therapy for axial spondyloarthritis is continuous NSAID use, which reduces pain and inflammation. Sulfasalazine and methotrexate are used for peripheral arthritis but have limited efficacy for axial disease. Allopurinol is for crystal arthropathy.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.