American Board of Internal Medicine (ABIM) Certification Practice Exam

Which therapy is indicated for ankylosing spondylitis that does not respond to NSAIDs?

1. Glucocorticoids

2. Tumor necrosis factor α inhibitor etanercept

3. Non-steroidal anti-inflammatory drugs

4. Interleukin-6 inhibitors

The correct answer is: Tumor necrosis factor α inhibitor etanercept

In the management of ankylosing spondylitis (AS), non-steroidal anti-inflammatory drugs (NSAIDs) are typically the first line of treatment. However, in cases where patients do not adequately respond to NSAIDs, more advanced therapies are indicated. Tumor necrosis factor (TNF) α inhibitors, such as etanercept, are specifically designed to target the inflammatory processes involved in AS. TNF-α is a cytokine that plays a crucial role in inflammation and is often found in elevated levels in patients with ankylosing spondylitis. By inhibiting this cytokine, TNF-α inhibitors can significantly reduce inflammation, improve clinical symptoms, and enhance physical function in patients who have insufficient response to traditional NSAID therapy. Glucocorticoids are another class of anti-inflammatory medications, but they are generally not considered the first choice for managing chronic inflammatory conditions like ankylosing spondylitis, especially when other specific therapies are available. Non-steroidal anti-inflammatory drugs are the starting treatment, while interleukin-6 inhibitors have a more limited role and are not standard treatments for AS compared to TNF-α inhibitors. Therefore, for patients with ankylosing spondyl