Lead Author Joel D. Taurog, MD Comments – Written by Christopher Chalk, DC, MPH
Providers who treat back pain often lack a clear understanding of the presentation, diagnostic workup and treatment options for axial spondyloarthritis (SpA), according to a paper recently published in The New England Journal of Medicine.
Joel D. Taurog, MD, Burnett Professor for Arthritis Research at the University of Texas Southwestern Medical Center discussed with SpineUniverse this lack of understanding stating, “Individuals with axial spondyloarthritis frequently go for many years being misdiagnosed and inappropriately treated before being referred to a rheumatologist.” The prevalence of axial SpA, of which ankylosing spondylitis is a subset, is similar to that of rheumatoid arthritis, highlighting the clinical importance of the paper’s main finding. 
Background and History
Magnetic resonance imaging (MRI) in the 1990s helped to solidify the understanding that spinal and sacroiliac inflammation occurs before definitive sacroiliitis can be demonstrated on radiographs. In 2000, TNF inhibitors were found to be dramatically effective in alleviating the symptoms of ankylosing spondylitis, advancing efforts in diagnosing and classifying early disease.
Classification
Inflammatory back pain has a 70% to 80% sensitivity as a diagnostic indicator for axial SpA. Common signs and symptoms of inflammatory back pain include dull lower back and buttock pain of insidious onset that is initially intermittent but persistently progresses. The pain diminishes with activity but can return with inactivity and is associated with morning stiffness of 30 minutes or more.
Additionally, according to Dr. Taurog, nocturnal exacerbation of pain is common, “Particularly during the second half of the night, forcing the patient to rise and move around.” He adds that pain is often present in the thoracic spine as well. “Cervical involvement typically occurs late but can predominate. Pain in the chest occurs in more than 40% of patients with spondyloarthritis.”