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Recognizing Axial Spondyloarthritis: A Guide for Primary Care
Marina N Magrey1, Abhijeet S Danve2, Joerg Ermann3
1MetroHealth System and School of Medicine, Division of Rheumatology, Case Western Reserve University, Cleveland, OH.
Mayo Clinic Proceedings
|August 2, 2020
Summary
Axial spondyloarthritis (axSpA) causes chronic low back pain. Early recognition of inflammatory back pain (IBP) and SpA features is crucial for timely diagnosis and effective treatment.
Area of Science:
- Rheumatology
- Immunology
Background:
- Axial spondyloarthritis (axSpA) is a significant cause of chronic low back pain, affecting about 1% of the US population.
- Inflammatory back pain (IBP) is a characteristic symptom of axSpA, often presenting insidiously before age 45 with morning stiffness and improving with exercise.
Purpose of the Study:
- To review the key features of axSpA and IBP.
- To emphasize the importance of early diagnosis and referral for axSpA.
- To guide clinicians in identifying and managing patients with potential axSpA.
Main Methods:
- A literature search of English-language articles was conducted using PubMed.
- Search terms included axSpA, ankylosing spondylitis, inflammatory back pain, chronic back pain, diagnosis, and referral.
- The review was supplemented with clinical expertise.
Main Results:
- IBP features include insidious onset, morning stiffness, exercise improvement, alternating buttock pain, and good response to NSAIDs.
- Associated SpA features include enthesitis, dactylitis, peripheral arthritis, extra-articular manifestations, HLA-B27 positivity, and family history.
- AxSpA is often underrecognized, leading to diagnostic delays.
Conclusions:
- Screening for IBP and SpA features in patients with chronic back pain is essential.
- Suspicion of axSpA warrants referral to a rheumatologist for further evaluation.
- Early diagnosis and treatment of axSpA are critical due to the availability of new therapies.
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