American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended treatment for patients with ankylosing spondylitis if first-line therapy with NSAIDs is inadequate?

1. Tumor necrosis factor α inhibitor

2. Biologic response modifier

3. Corticosteroids

4. Interleukin-6 inhibitor

The correct answer is: Tumor necrosis factor α inhibitor

The recommended treatment for patients with ankylosing spondylitis, when first-line therapy with non-steroidal anti-inflammatory drugs (NSAIDs) proves inadequate, is the use of tumor necrosis factor (TNF) α inhibitors. Ankylosing spondylitis is a progressive inflammatory rheumatic disease primarily affecting the spine and sacroiliac joints, and it often leads to chronic pain and stiffness. While NSAIDs are considered the standard first-line treatment for managing pain and inflammation in these patients, some patients may experience insufficient relief or may not tolerate NSAIDs well. Given this scenario, TNF α inhibitors, such as etanercept, infliximab, or adalimumab, have been shown to be effective in clinical trials for reducing symptoms and improving functional outcomes in ankylosing spondylitis patients who do not respond adequately to NSAIDs. These biologic agents target and inhibit the action of TNF α, a pro-inflammatory cytokine that plays a key role in the inflammatory processes of ankylosing spondylitis. In contrast, although biologic response modifiers encompass a broader category that could include TNF α inhibitors and others, the specific and recommended treatment protocol typically highlights TNF α inhibitors for