19th January 2024

A 32-year-old male presents with a 3-month history of back pain and stiffness, which he describes as being worse first thing in the morning, but gradually improves throughout the day.

A 32-year-old male presents with a 3-month history of back pain and stiffness, which he describes as being worse first thing in the morning, but gradually improves throughout the day. He is otherwise fit and well and works as a builder. His father had a skin condition which he cannot remember the name of. Blood test results showed the following.

Hb 140 g/L (130-180)

MCV 90fL (80-96)

WCC 5.0 x 10⁹/L (4.0-11.0)

CRP 26 mg/L (<10)

Sodium 138 (133–146 mmol/L)

Potassium 3.9 (3.5–5.3 mmol/L)

Creatinine 60 (45–84 μmol/ L)

EGFR >90 

ESR 5

LFTs normal 

Rheumatoid factor 8 (0-20 u/mL)

Anti-CCP negative 

An x-ray of his spine revealed right-sided sacroiliitis and presence of scattered syndesmophytes on the same side.

He has tried a course of oral ibuprofen and oral naproxen, which failed to improve his symptoms. 

What is the most appropriate next-line treatment for this man?

Select the SINGLE most appropriate option from the list below. Select ONE option only.