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Inflammatory back pain affects approximately 3% of adults.1 This kind of back pain is often mistaken for mechanical back pain. There are several conditions that can cause inflammatory back pain, some of which are difficult to diagnose. Fortunately, in the last 10 years, scientific advances have made it easier for doctors to identify some of these conditions, and to manage them.2

Inflammatory back pain can impact your life in many ways. It is important to work with your doctor to find out whether your pain is inflammatory because this can impact how the pain is managed in the future. Early diagnosis is also important  as some causes of back pain may become worse over time.

Although you may find that exercise or painkillers purchased from your pharmacy may ease some of your symptoms,it is still important that you go to your doctor to be diagnosed properly.

Could your back pain be due to inflammation? Complete the Symptom Checker and find out.

FEATURES OF INFLAMMATORY BACK PAIN2,3

Inflammatory back pain can have certain features that distinguish it from other types of back pain, specifically mechanical back pain. These features include:

  • Young age at onset, typically seen in those under 40 years old
  • Gradual onset of pain
  • Symptoms of back pain improve with exercise
  • Pain does not improve with rest
  • Pain at night, often waking a person in the second half of the night
  • Morning stiffness that lasts for more than 30 minutes
  • Pain lasting for more than 3 months
  • Alternating buttock pain

WHAT CAUSES INFLAMMATORY BACK PAIN?

Inflammatory back pain may be caused by certain autoimmune diseases.4 Some autoimmune conditions that are linked closely to back pain are non-radiographic axial spondyloarthritis, ankylosing spondylitis, psoriatic arthritis and reactive arthritis.

It is important that inflammatory back pain is recognised and diagnosed so that it may be managed properly.

AUTOIMMUNE CONDITIONS ASSOCIATED WITH INFLAMMATORY BACK PAIN

An autoimmune condition is when the body is attacking itself and its own healthy tissue. There are several types of autoimmune conditions and some of these are very closely linked to inflammatory back pain.

Axial spondyloarthritis is an umbrella term for two conditions that cause inflammatory back pain, ankylosing spondylitis and non-radiographic axial spondyloarthritis.

  • Ankylosing spondylitis – this is a form of inflammatory arthritis in which joints of the spine become inflamed, often leading to stiffness and pain in the back. The damage to the spine and joints connecting the spine to the pelvis from this condition can be seen on X-ray.5

  • Sometimes, patients may experience pain and limited movement, even though doctors are unable to see any inflammation on an X-ray. This is known as non-radiographic axial spondyloarthritis.5 In this case, more advanced ways of looking at the joints are needed, such as a magnetic resonance imaging (MRI) scan. Non-radiographic axial spondyloarthritis and ankylosing spondylitis share many symptoms.5

Other inflammatory arthritic conditions – some arthritic conditions that lead to inflammatory back pain can start in different parts of the body. These inflammatory arthritic conditions can affect the skin (psoriatic arthritis),6 eyes or urinary tract (reactive arthritis),7 intestines or bowels (enteropathic arthritis)8 or joints (rheumatoid arthritis).9

Although symptoms of these diseases most often include tenderness and swelling in the affected joints or tissues, in many people, this can also develop into inflammatory back pain.

There is no simple test for most of these conditions. To help diagnose these disorders, doctors may complete a physical examination, perform MRI imaging and/or order blood tests to check for genetic markers.

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SYMPTOM CHECKER

There are different types of back pain and it's important to find out which type of pain you have, so it can be managed appropriately. If you have had back pain for more than 3 months, you should complete our short Symptom Checker to help you and your doctor understand if your back pain is more likely to be inflammatory.

REFERENCES

  1. Hamilton L, Macgregor A, Warmington V, et al. The prevalence of inflammatory back pain in a UK primary care population. Rheumatology (Oxford) 2014;53:161-4.
  2. Sieper J, et al. The Assessment of SpondyloArthritis International Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis. 2009;68:ii1–ii44.
  3. National Ankylosing Spondylitis Society (NASS). Differentiating inflammatory and mechanical back pain. 2012.
  4. Cohen SP, et al. Management of low back pain. BMJ. 2008;337:a2167
  5. Rudwaleit M, van der Heijde D, Landewe R, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis. Part II: Validation and final selection. Ann Rheum Dis. 2009;68:777–783.
  6. Gladman DD, Antoni C, Mease P, Clegg DO, Nash P. Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis. 2005;64(Suppl II):ii14-7.
  7. Agarwal MP, Giri S, Sharma V, Bhardwaj G. Concurrent reactive arthritis and myelitis - a case report. Int Arch Med. 2009;2:17.
  8. Kiratiseavee S, Brent LH. Spondyloarthropathies: using presentation to make the diagnosis. Cleve Clin J Med. 2004;71:184-206.
  9. Aletaha D, Neogi T, Silman AJ, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010;62:2569-81.