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Referral & assessment
Inflammatory vs Mechanical Back Pain
Spotting axial spondyloarthritis among the many patients with chronic back pain.
Video lesson
Key points
Inflammatory features: onset before 45, insidious onset, duration over 3 months, morning stiffness, improvement with exercise but not rest, night pain in the second half of the night, and alternating buttock pain. Associated clues include uveitis, psoriasis, IBD, heel enthesitis and family history.
Practical approach
Check CRP and HLA-B27. Order MRI of the sacroiliac joints with STIR sequences when X-rays are normal and suspicion is moderate to high. Refer patients with chronic back pain plus two or more inflammatory features.
Pearls
Average diagnostic delay in axSpA is still 7 to 10 years. A trial of full-dose NSAID with good response is a supportive clue.
At a glance
Category
Referral & assessment
Reviewed by Farhan Tahir, MD, FACR
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