Inflammatory Back Pain and the Diagnosis of Axial Spondyloarthritis

Back pain is one of the most common musculoskeletal problems in the United States. A small portion of these patients will develop chronic back pain lasting more than 3 to 6 months. These patients are often referred to musculoskeletal specialists for evaluation of potential underlying conditions, including spondyloarthritis (SpA), a group of related systemic disorders formerly known as the seronegative spondyloarthropathies (SNSA). Axial SpA encompasses ankylosing spondylitis, psoriatic arthritis, enteropathic (inflammatory bowel disease related) arthritis, and reactive arthritis due to select enteric and genitourinary infections. Consideration should be given to the possibility of axial SpA in patients with chronic back pain because its prevalence approaches that of rheumatoid arthritis. Orthopedic surgeons' knowledge of inflammatory back pain and other clinical features of SpA will facilitate the appropriate referral of patients to rheumatology for diagnostic confirmation and specific treatment.