Has Your Patient Had Inflammatory Back Pain for 3+ Months?

If your patient’s back pain is not improving and is inflammatory in nature, your patient may have an undiagnosed rheumatic disease – axial spondyloarthritis (axSpA), including ankylosing spondylitis (AS) – that primarily affects the spine, which can make them highly prone to spinal fracture.

Inflammatory back pain is a hallmark of axSpA and other closely related diseases within the spondyloarthritis family of diseases.

Now Offering Continuing Education Hours for Chiropractors (PACE)!

Spotting Axial Spondyloarthritis in Chiropractic Settings: Is AxSpA Behind Your Patient’s Back Pain?

Credit Available

DC Continuing Education — 1 CE hour

All other healthcare professionals completing this course will be issued a statement of participation.

This course is valid for continuing education credit in the following states, so long as it falls within the scope of practice as outlined by the corresponding state board: Please refer to the following chart for specific details about your state.*

Target Audience
This activity is designed to meet the educational needs of DC and DC students.

Program Overview
This activity will help increase knowledge and awareness of axial spondyloarthritis (axSpA) among Chiropractors, giving them tools to appropriately suspect, and refer axSpA patients to rheumatology, with the ultimate goal of improving patient outcomes. This activity is supported by The Spondylitis Association of America.

Characteristics of Inflammatory Back Pain

Inflammatory back pain is usually characterized by a dull ache, difficult to localize, and felt deep in the buttocks or lower back. It may persist for three months or longer. This back pain is frequently associated with stiffness and spasm of the paraspinal muscles and inflammation of the sacroiliac (SI) joints. In some cases, axSpA symptoms can also start in the neck or peripheral joints such as the hips, shoulders, or knees.

Prolonged inactivity usually worsens the pain and stiffness, while exercise and physical activity tend to ease them. Pain may awaken the patient at night. Some patients find it necessary to exercise or move about for a few minutes before returning to bed and may have difficulty getting out of bed in the morning.

Patients with AS may have a fused spine and an 11 times higher risk of spinal fracture.

“AxSpA causes inflammation of the joints between the vertebrae of the spine and the sacroiliac joints in the pelvis. It can also cause inflammation and pain in other parts of the body. In those with AS, as the condition worsens and the inflammation persists, new bone forms as a part of the healing process. The bone may grow from the edge of the vertebra across the disc space between two vertebra, resulting in a bony bridge. This may occur throughout the spine so that the spine may become stiff and inflexible, effectively fusing the spine.”

— Bryan E. Bledsoe, DO, FACEP

Important Points to Look For

Onset is usually insidious and begins before age 45.
Pain persists for more than three months (i.e., it is chronic).
Back pain and stiffness worsen with immobility, especially at night and early morning.
Back pain and stiffness tend to ease with physical activity and exercise.

Other Signs and Symptoms of Axial Spondyloarthritis

Enthesitis

Inflammation of the entheses, where joint capsules, ligaments, or tendons attach to bone, is a hallmark of axSpA and other forms of spondyloarthritis. This can be felt in multiple areas of the body from the shoulders down to the feet. Two areas of the foot can be affected: the Achilles tendon at the back of the heel and the plantar fascia at the base of the heel.

Dactylitis (Sausage Digits)

Inflammation of an entire digit (a finger or toe).

Iritis/Uveitis

Inflammation of the eye. It is a serious complication that requires immediate medical attention from an eye doctor. Symptoms often occur in one eye at a time, and they may include redness, pain, sensitivity to light, and skewed vision. If left untreated, it can lead to blindness.

Psoriasis and Inflammatory Bowel Diseases

These conditions are also associated with axSpA and related diseases, and can serve as additional clues.

Additional Resources for You and Your Patients

Learn more about axial spondyloarthritis, ankylosing spondylitis, and the group of diseases known as spondyloarthritis.

Overview of axSpA and Related Diseases

The Spondylitis Association of America (SAA) can assist in the search for a rheumatologist by providing our free Rheumatologist Directory: A Patient-to-Patient Recommended List. This booklet contains a state-by-state list of patient-recommended, board-certified rheumatologists.

Rheumatologist Directory

We proudly offer a wealth of educational materials on axial spondyloarthritis, ankylosing spondylitis and related diseases — all vetted by our Medical and Scientific Advisory Board.

Educational Materials