Chronic Back Pain – When Should We Remember Inflammatory Rheumatic Diseases?
DOI: 10.3238/zfa.2011.0317german translation / full article
Summary: Inflammatory rheumatic diseases, such as ankylosing spondylitis (AS) and the whole group of spondyloarthritiden (SpA), are relevant differential diagnoses in patients with chronic back pain. The diagnosis of AS is often delayed by 5 to 10 years, mainly because radiographs do not reveal definite radiographic sacroiliitis at the early disease stage and because of the late referral to a rheumatologist. An easy strategy for the recognition of patients with high probability of the AS/SpA on the primary care level has been developed and validated recently. Patients with chronic back pain and back pain onset before 45 years of age should be referred to a rheumatologist if at least one of the following is present: morning stiffness in the spine with improvement on exercise, HLA-B27 positivity, or signs of sacroiliitis as detected by imaging.