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.
