Description

Poddubnyy et al listed criteria for when a patient with back pain should be referred to a rheumatologist for possible axial spondyloarthritis. The authors are from the Assessment of SpondyloArthritis international Society (ASAS).


Criteria for referral:

(1) chronic back pain (lasting for >= 3 months)

(2) age at onset less than 45 years

(3) one or more of the following:

(3a) inflammatory back pain (see below)

(3b) HLA-B27

(3c) sacroiliitis on imaging studies

(3d) positive family history for spondyloarthritis (in first or second degree relatives)

(3e) good response to non-steroidal anti-inflammatory drug (NSAID)

(3f) peripheral manifestations (arthritis, enthesitis, dactylitis)

(3g) extra-articular manifestations (uveitis, psoriasis, inflammatory bowel disease)

(3h) elevated acute phase reactant (CRP or ESR) with no other explanation

 

where:

• A good response to NSAID is absence or significant improvement in back pain within 48 hours after full dose of NSAID.

• Inflammatory back pain - 4 or 5 of the following: onset <= 40 years of age; insidious onset; improvement with exercise; no improvement with rest; pain at night with improvement upon arising.


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