American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the first-line therapy for ankylosing spondylitis?

1. Corticosteroids

2. DMARDs

3. NSAIDs

4. Biologics

The correct answer is: NSAIDs

The first-line therapy for ankylosing spondylitis is nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs are particularly effective in managing the inflammatory pain associated with ankylosing spondylitis and play a crucial role in reducing stiffness and improving mobility. The mechanism of action involves the inhibition of cyclooxygenase enzymes, which decreases the production of prostaglandins responsible for inflammation and pain. In the early stages of ankylosing spondylitis, treatment typically starts with NSAIDs due to their efficacy and relatively favorable side effect profile. Patients often experience significant symptomatic relief from NSAIDs, which can help manage the chronic pain and discomfort that come with this condition. Corticosteroids, while effective in reducing inflammation, are generally reserved for more severe cases or when other treatment options have failed, as they can have more significant side effects when used long-term. Disease-modifying antirheumatic drugs (DMARDs) are more commonly utilized in other inflammatory arthritis conditions but are not the primary treatment for ankylosing spondylitis. Biologics are advanced therapies used in cases that are refractory to NSAIDs or when the disease is particularly aggressive, but they are not considered first-line treatment. Therefore,