Getting My Diagnosis

Do I have inflammatory back pain?

You may have inflammatory back pain if you answer yes to at least 4 of the 5 of the statements below.

Back pain of more than 3 months duration is inflammatory if:

  • Age at onset less than 40 years
  • The pain started slowly
  • Improvement with exercise
  • No improvement with rest
  • Pain at night (with improvement on getting up)

What is inflammatory back pain?

Back pain is very common but in most cases the pain is said to be ‘mechanical' - that is, related to the way the muscles, ligaments, discs and bones work together.  For a small number of people, the pain is due to inflammation in the back. 

Inflammation is the body's reaction to injury or irritation, and can cause redness, swelling and pain.

It is important to be able to distinguish inflammatory pain from mechanical pain, as the treatment is different.

What are the symptoms of inflammatory back pain?

Typically, inflammatory back pain:

  • Starts before the age of 40 years
  • Has been present for at least 3 months
  • Has come on slowly over time
  • Is worse in the mornings
  • Causes stiffness in the mornings lasting for at least 30 minutes (stiffness is perhaps best described as the sort of aching you get the day after heavy exercise)
  • Improves with exercise, and is worse with rest
  • Improves with anti-inflammatory drugs (e.g. ibuprofen)
  • Can wake people from sleep, often in the second half of the night
  • Can often cause pain in the buttocks, but rarely pain shooting down the leg (sciatica)

Spondyloarthritis

Inflammatory back pain is the main symptom of a group of conditions called spondyloarthritis. 

Four main conditions make up the spondyloarthritis family.

Enteropathic arthritis

Enteropathic arthritis is strongly linked with inflammatory bowel disease, particularly ulcerative colitis and Crohn's disease. It may affect any joint but often affects the feet, ankles and knees.

Reactive arthritis

Reactive arthritis is also known as Reiter's syndrome. It develops as a reaction to an earlier infection. It is thought that reactive arthritis occurs when the immune system over-reacts to an infection and inflames healthy tissue in areas of the body including the joints, eyes and urethra.

The two most common types of infection linked to reactive arthritis are bowel infections and sexually transmitted infections. Reactive arthritis is quite different from other forms of arthritis which may be provoked by viral infection, such as hepatitis and parvovirus.  

The outlook for reactive arthritis is reasonably good, and most people's symptoms will get better within 3 to 12 months. Some people's symptoms will recur at some point in the future and in a small number of people the symptoms will persist.

Psoriatic arthritis

Psoriatic arthritis may cause inflammation in the hands, feet, larger joints or the spine. The majority of people who develop psoriatic arthritis do have skin psoriasis, but some develop arthritis before they notice any psoriasis on their skin.

Good sources of help and advice are:

The Psoriasis Association

Psoriasis and Psoriatic Arthritis Alliance

What should I do?

NASS strongly  recommend that all patients with inflammatory back pain are referred by their GP to a rheumatologist for assessment.

Next steps to diagnosis.

What treatments are available for inflammatory back pain?

It is managed through a combination of pain relief and exercise.

Will changing my lifestyle help?

The two most important changes you can make is to start exercising and to stop smoking. There is little proof that changing your diet will help.

Last reviewed: October 2014

Inflammatory Arthritis

You may have inflammatory back pain if you answer yes to at least 4 of the 5 statements below.

Back pain of more than 3 months duration is inflammatory if:

• Age at onset less than 40 years.
• Insidious* onset.
• Improvement with exercise.
• No improvement with rest.
• Pain at night (with improvement on getting up).

* It started slowly: it did not come on suddenly.

ASAS Criteria (Sieper J Et al Ann Rheum Disease 2009;68:784-8)