What is the FIRST LINE treatment for AS?

• A. Physical therapy
• B. Methotrexate
• C. NSAIDs (Indocin)
• D. TNF inhibitors

Answer: (C)

The first-line approach for ankylosing spondylitis is to control inflammation and pain with nonsteroidal anti-inflammatory drugs. These medications directly reduce inflammatory back pain and morning stiffness, helping improve spinal mobility and function. Indomethacin is a classic example used to illustrate this option. While physical therapy and exercise are essential supports to maintain posture and flexibility, they are used alongside NSAIDs rather than as the sole initial treatment. Methotrexate generally doesn’t improve axial (spine) inflammation, though it might help peripheral arthritis. TNF inhibitors are powerful options for patients who don’t respond to NSAIDs or have more aggressive disease, but they’re not considered first-line due to cost, safety considerations, and the good response many patients get from NSAIDs.