Your Diagnosis

Getting a diagnosis of axial spondyloarthritis (axial SpA) including ankylosing spondylitis (AS)

This information is for anyone with axial spondyloarthritis (axial SpA) including people with ankylosing spondylitis (AS)

What is inflammatory back pain?

Back pain is very common but in most cases the pain is ‘mechanical’. This means the pain is related to the way the muscles, ligaments, discs and bones work together.  Inflammatory back pain affects a much smaller number of people.

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.

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

Four main conditions make up the spondyloarthritis family.

  1. Axial spondyloarthritis  (axial SpA) including ankylosing spondylitis (AS)
  2. Enteropathic arthritis which is strongly linked with inflammatory bowel disease. It often affects the feet, ankles and knees
  3. Psoriatic arthritis may cause inflammation in the hands, feet, larger joints or the spine. The majority do have skin psoriasis, but some develop arthritis before they notice any psoriasis on their skin
  4. Reactive arthritis which is also known as Reiter’s syndrome. It develops as a reaction to an earlier infection, including bowel infections  and sexually transmitted infections. Most people’s symptoms will get better within 3 to 12 month

Use our Symptom Checker

Check out this video from Professor Raj Sengupta on spotting the signs of axial spondyloarthritis.

 

Getting your axial SpA diagnosis

Your first step is to go to your GP

You should be ready to explain:

  • What symptoms you are experiencing
  • How long these have been going on (weeks, months, years)
  • How the symptoms started (suddenly or came on slowly over time)
  • What impact your symptoms are having on your daily life and what are they stopping you from doing (be sure to highlight any issues around sleeping and work)

If another member of your family has axial SpA please make sure that you highlight this to your GP. If you have ever suffered with any of the following problems please also highlight this.

Watch this video where GP, Dr Daniel Murphy, gives advice on talking to your GP about axial SpA.

Referral to a rheumatologist

Only a rheumatologist can make a definite diagnosis of axial SpA so it’s important that your GP does refer you. In some areas you will need to go through MSK Triage first. The video below gives advice on preparing for your rheumatology appointment and gives you an idea of what to expect.

And Dr Aisling Coy talks about how axial SpA is diagnosed by a rheumatologist.

Tests which might be used to confirm your axial SpA

Tests which might be used to confirm your axial SpA diagnosis include:

  • Physical examination by a nurse, physiotherapist or rheumatologist to assess your flexibility and joint tenderness.
  • Blood test to look at inflammatory markers. If you have inflammation in a part of your body then extra protein can be  released from the site of inflammation and circulates in the bloodstream. The erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and plasma viscosity (PV) blood tests are commonly used. Do remember that in around half of all cases, inflammatory markers will be within the normal range. If your inflammatory markers are normal it doesn’t necessarily mean you don’t have inflammatory arthritis.
  • A blood test which can identify if you carry the HLA-B27 gene. The HLA B27 gene is present in over 90% of people with axial SpA. Just carrying the HLA-B27 gene does not necessarily mean you have axial SpA or that you will go on to develop it but it’s a clue that your symptoms might point towards axial SpA.  Do remember 10% of people with axial SpA are HLA-B27 negative.
  • X-rays will show if there has been any changes to your bones and joints such as extra bone growth or fusion. Many people will never have changes on x-ray.
  • Magnetic resonance imaging (MRI) which will show if there is any inflammation around your joints. A particular MRI sequence needs to be used to diagnose axial SpA. It is called a STIR sequence (Short TI Inversion Recovery).

In this video Dr Poonan Sharma discusses the tests and investigations that may be used to confirm your diagnosis.

Find out more