APLAR Short Course on SpA Post Course Assessment

This assessment consists of 14 questions. Candidates are required to provide a response to each question, for a total of 14 responses.

To successfully pass this assessment, candidates must answer at least 9 out of 14 questions correctly. Participants who successfully pass this assessment will be awarded a Certificate of Completion.

PRE-TEST AND POST-TEST (ONLY INTERNAL USE IN THIS COURSE)

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What is the least helpful information in diagnosing spondyloarthritis in a patient with low back pain?

A. Positive HLA-B27

B. Back pain when sneezing

C. Bilateral sacroiliitis in pelvis x-ray

D. Family history of ankylosing spondylitis

E. Concomitant Achilles tendinitis, right ankle

None

Which of these are true? (You may choose more than 1 answer)

A. Butyrate is an important short chain fatty acid implicated in regulation of the immune system at the intestinal level

B. Treatment with TNF inhibitors and IL-17 inhibitors result in no change in the microbiome from baseline

C. Abundance of bacteria in the genus Dialister is positively correlated with disease activity in AS

D. Reduction in Faecalibacterium prausnitzii is observed only in AS patients

Compared with TNF inhibitors, which of the following is a characteristic of IL-17 inhibitors in spondyloarthritis (SpA)?

A. Inferior efficacy in axial arthritis

B. Increased risk of tuberculosis

C. Better efficacy in skin psoriasis

D. No concern regarding Candida infection

None

Regarding radiographic assessment of axial SpA, which of the following is false?

A. Radiographic changes of sacroiliitis take many years to manifest

B. Radiography has low accuracy for identification of sacroiliitis

C. Low dose CT is an accurate method of identifying sacroiliitis

D. Radiographs are sensitive at revealing the spinal features of SpA

E. Fractures are an uncommon feature of established axial SpA

None

Following this lecture, which statement best reflects your approach to selecting a PET/CT tracer for a challenging axSpA case? (You may choose more than 1 answer)

A. I will now consider FDG-PET/CT primarily to confirm and quantify active inflammatory processes when MRI is equivocal or unavailable.

B. I will now consider Sodium Fluoride (NaF)-PET/CT to specifically assess active bone formation and structural progression, especially in established disease.

C. I see a future role for novel tracers (e.g., FAPI-PET/CT) for profiling tissue phenotypes, such as detecting early fibrotic change, within clinical trials or specialized centers.

D. I now recognize the distinct applications, but my ability to apply this is limited by local availability and guidelines.

Which of the following best explain why treating PsA early:

A. achieving better clinical outcomes

B. preventing joint damage

C. preserving physical function

D. reducing cardiovascular atherosclerosis

E. all of the above

None

What are the correct statements:

A. The aberrant immune response that leads to PsA may originate in the skin, intestinal mucosa or entheses

B.Activation of IL-23/IL-17 axis is common to psoriasis and PsA

C. PsA may be intercepted by early treatment of psoriasis with phototherapy and topical steroids

D. Some biologics may be more powerful in intercepting PsA and preventing the transition from psoriasis to PsA

E. According to EULAR nomenclature , the sub-clinical phase of PsA is characterized by the presence of arthralgia and/or evidence of synovio-entheseal inflammation without clinical synovitis

None

Visible Musculoskeletal changes on imaging with no clinical findings are characteristic of :

A. The pre-clinical phase

B.The subclinical phase

C. The Prodromal phase

D. The PsA disease phase

None

Which scenario best reflects current evidence on preventing structural bone damage progression in psoriatic arthritis (PsA) when using HR pQCT to assess erosions and enthesiophytes?

A. Patients with psoriasis (PsO) showing structural bone changes on HR pQCT have a low likelihood of developing PsA, regardless of inflammation control

B. IL 17 inhibitors and sustained low disease activity are associated with reduced progression of HR pQCT detected erosions/enthesiophytes, supporting inflammation suppression to prevent pathological bone remodeling

C. Structural bone change on HR pQCT is unrelated to future PsA development and thus not useful for risk stratification in PsO

D. HR pQCT is inferior to radiography for detecting progression of enthesiophytes over short intervals

E. Achieving low disease activity has no impact on HR pQCT measures of structural progression if erosions are already present

None

10.

What percentage of PsA cases are difficult to treat as defined by failure of two biological therapies?

A.5%

B. 10%

C. 12%

D. 15%

E. 20%

None

11.

What is the common underlying pathophysiological mechanism of skin, eye, and gut comorbidities of spondyloarthritis, and what is the most effective therapy for severe psoriasis?

A.IL-6 pathway, meth

B. IL-17/IL-23 axis, IL-17 inhibitors

C.TNF-α signaling pathway, NSA

D.HLA-B27 misfolding, corticosteroids

None

12.

Which is / are correct statement regarding MSK ultrasound (USG) in spondyloarthritis?

A. USG is very sensitive to detect the inflammation in SI joints

B. USG can be used to localize SI joint to assist injection

C. With latest advancement of technology, one can identify bone marrow edema in the SI joints

D. USG can be used to study the joint erosion of the SI joints

E. Bubble contrast ultrasound should be used in assessing SI joints

None

13.

Which of the following sequences is preferred if only one sequence is performed in the semi-axial plane?

A. Short-tau inversion recovery (STIR)

B. T1-w spin echo (SE)

C. T1-w spin echo Dixon sequence

D. T2-w spin echo Dixon sequence

E. 3D gradient echo with fat saturation images (T1 3D GE FS)

None

14.

In patients with suspected axial spondyloarthritis, which MRI technique is most appropriate for detecting erosive damage of the sacroiliac joints?

A. STIR sequence

B. Oblique coronal T1-weighted images

C. Axial T2 fat-saturated images

D. 3D gradient echo sequences (e.g. VIBE)

E> Post-contrast T1 fat-saturated images

None

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APLAR Short Course on SpA Post Course Assessment

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