Inflammatory Back Pain

Warning

Patient Resources

 

Clinican Resources

 

Definition

Axial Spondyloarthritis is a chronic inflammatory condition targeting the sacroiliac joints and the spine. It typically starts in the late teens and early 20’s but can present in people up to 45 years of age. It has been estimated that AxSpA accounts for <5% of chronic back pain.

 

History

  • Back pain > 3months with onset <45yrs of age
  • Does not improve on resting
  • Insidious onset
  • Pain at night improving on rising
  • Early morning stiffness improving with exercise
  • Good response to NSAID

 

Associated features

  • History of iritis or uveitis
  • History of psoriasis
  • History of inflammatory bowel disease
  • Positive family history of AxSpA
  • Peripheral large joint synovitis
  • Heel pain (enthesitis)
  • Buttock pain alternating with back pain
  • Dactylitis of fingers or toes

 

Examination

  • Reduced range of spine movements
  • Peripheral joint examination for synovitis

 

Additional features of AxSpA

  • Good response to NSAID
  • Raised CRP or ESR (may be normal)
  • Routine bloods otherwise unremarkable
  • HLA B27 usually positive 

 

Other Considerations

  • Affects a similar number of women as men
  • May be present despite no evidence of sacroiliitis on a plain film X-Ray

Editorial Information

Last reviewed: 01/10/2024

Next review date: 01/11/2026

Author email(s): LOTH.MSKPathways@nhs.scot.