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Answer 5 quick questions in the Symptom Checker to help find out if your back pain could be due to inflammation. 

Inflammatory back pain affects up to 3% of people.1,2 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, to manage and treat them.3

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. Your doctor may refer you to a specialist.

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

FEATURES OF INFLAMMATORY BACK PAIN3,4

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

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

WHAT CAUSES INFLAMMATORY BACK PAIN?

Most inflammatory back pain is caused by certain autoimmune conditions. An autoimmune condition can occur when the body’s immune system mistakenly attacks healthy body tissue.5 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 and sacroiliac joint in the pelvis become inflamed, often leading to stiffness and pain in the back. Changes to the bones and eventual fusion of the spine may result. The damage to the spine and joints of the hips from this condition can be seen on X-ray.6

Patients may experience inflammatory back pain and limited spinal flexibility, even though doctors are unable to see any inflammation changes on an X-ray. This is known as non-radiographic axial spondyloarthritis.6 In this case, more advanced ways of looking at the joints are needed, such as a magnetic resonance imaging (MRI) scan.6 Non-radiographic axial spondyloarthritis and ankylosing spondylitis share many symptoms, even though imaging evidence may differ.6

Patients with inflammatory back pain may have other clinical features associated with spondyloarthritis. These include peripheral arthritis7, psoriasis8  (a scaly skin rash), eye inflammation (uveitis)7,9, inflammatory bowel disease (Crohn’s disease, ulcerative colitis)7,9  and/or pain at tendon insertion sites such as the Achilles tendon (enthesitis)7. These features may be present before or after the onset of back pain. Occasionally spondyloarthritis develops after gastroenteritis or a sexually transmitted infection (reactive arthritis).9  Some patients may already have a diagnosis based on these features such as psoriatic arthritis, enteropathic arthritis or reactive arthritis.

There is no simple test for most of these conditions. To help diagnose these disorders, doctors may complete a physical examination, perform X-rays and/or order blood tests to check for genetic markers.4,10,11 GPs may also refer patients onto a Rheumatologist, an expert who specialises in diagnosing and managing these conditions.

If you think you may have inflammatory back pain take the symptom checker 

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SYMPTOM CHECKER

If you have had back pain for more than 3 months, check the symptoms of your back pain here. The results can help you and your doctor understand if your back pain could be inflammatory.

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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. Cohen SP, et al. Management of low back pain. BMJ. 2008;337: a2167
  3. Sieper J, et al. The Assessment of SpondyloArthritis International Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis. 2009;68:ii1–ii44.
  4. National Ankylosing Spondylitis Society (NASS). Differentiating inflammatory and mechanical back pain.2015.
  5. Lettre G, Rioux JD. Autoimmune diseases: insights from genome-wide association studies. Hum Mol Genet. 2008;17:R116-21.
  6. Rudwaleit M, Khan MA, Sieper J. The challenge of diagnosis and classification in early ankylosing spondylitis. Arthritis Rheum 2005;52(4):1000-8–1008.
  7. Kiratiseavee S, Brent LH. Spondyloarthropathies: using presentation to make the diagnosis. Cleve Clin J Med. 2004;71:184-206.
  8. 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):ii14-17.
  9. Agarwal MP, Giri S, Sharma V, Bhardwaj G. Concurrent reactive arthritis and myelitis - a case report. Int Arch Med. 2009;2:17.
  10. Sieper J et al. Ann Rheum Dis 2013;72:1621-7
  11. Sieper J et al. Ann Rheum Dis 2009;68:784-8