A 36-Year-Old Man with Known Ankylosing Spondylitis for the Last

A 36-year-old man with known ankylosing spondylitis for the last 7 years comes to the physician complaining of persistent back pain.  He describes aching pain at night and in the morning that slowly goes away during the day.  In the evening, he feels fine and prefers to do most of his activities then.  He takes high-dose naproxen, which previously relieved his pain but recently has had only moderate effect.  He was evaluated for right hip pain 6 months ago, but no joint involvement was diagnosed.
His vital signs are within normal limits.  Examination shows limited spinal mobility and sacroiliac joint tenderness.
Laboratory results are as follows:

Which of the following is the best next step in managing this patient?

A) Adalimumab
B) Methotrexate
C) Prednisone
D) Sulfasalazine
E) Thalidomide

Correct Answer:

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