American Board of Internal Medicine (ABIM) Certification Practice Exam

What should be administered to patients with active ankylosing spondylitis who are resistant to NSAID treatment?

1. Leukotriene receptor antagonists

2. Steroids

3. Tumor necrosis factor α inhibitor

4. Methotrexate

The correct answer is: Tumor necrosis factor α inhibitor

In patients with active ankylosing spondylitis who do not respond adequately to non-steroidal anti-inflammatory drugs (NSAIDs), the use of tumor necrosis factor α (TNF-α) inhibitors is a highly effective treatment option. TNF-α is a cytokine that plays a significant role in the inflammatory processes associated with ankylosing spondylitis. The introduction of TNF-α inhibitors has transformed the management of this condition, as these agents can significantly reduce inflammation, improve mobility, and enhance the quality of life for affected individuals. These medications specifically target and inhibit the action of TNF-α, which is often elevated in patients with ankylosing spondylitis, leading to a reduction in the inflammatory response and, consequently, alleviating symptoms such as pain and stiffness. Clinical trials have demonstrated that TNF-α inhibitors can lead to substantial improvements in symptoms and physical function for patients who have had insufficient response to NSAIDs. Other treatments, such as steroids, can also be used for patients with more severe symptoms, but they are generally considered an adjunct rather than a first-line treatment when disease-modifying agents like TNF-α inhibitors are available. In contrast, drugs such as methotrexate