A form of inflammatory arthritis affecting mainly the spine and pelvis, where back pain that improves with movement is a key clue
Axial spondyloarthritis is an inflammatory arthritis that mainly affects the spine and the joints of the pelvis. Ankylosing spondylitis is a well-known form of it. It tends to begin in early adulthood and is an important cause of long-standing back pain that is often mistaken for ordinary mechanical back trouble.
Written for patients and reviewed by Dr Liubov Borukhson, Consultant Rheumatologist (GMC 7021928).
The pattern of back pain is the most telling feature. Typical signs include:
Diagnosis brings together your history, examination, blood tests and imaging. The distinctive history of inflammatory back pain is often the first clue, and imaging of the spine and pelvis helps confirm the picture. A high-quality MRI is particularly important in axial spondyloarthritis, as it can show inflammation early, before changes appear on ordinary X-rays. Dr Borukhson will be glad to arrange or refer for the appropriate MRI promptly, so that the diagnosis is not held up.
Ultrasound can add useful information about inflammation where tendons attach to bone, a common feature of this group of conditions. Dr Borukhson uses point-of-care ultrasound during the consultation, so relevant areas can often be examined in the same visit. You can read more on the ultrasound clinic page.
The aims are to control inflammation, relieve pain and stiffness, and maintain mobility and posture over the long term. A consistent exercise and movement programme is an important part of care, alongside medication where needed, and the plan is agreed with you.
Effective treatments are available to settle the inflammation, and these are reviewed over time. Because the condition is long-term, regular specialist input helps keep it well controlled.
Inflammatory back pain is frequently missed for years. In the UK it takes around seven years on average to reach a diagnosis of axial spondyloarthritis, and that delay matters: left untreated, the condition can cause permanent, irreversible damage to the spine. Recognising it early allows treatment and exercise to begin sooner, which helps protect movement and quality of life. For this reason it is important not to put off a review. If you have long-standing back pain that improves with activity or started before 45, it is worth seeing a specialist sooner rather than later.
If your back pain eases with activity or began before age 45, a specialist assessment can establish whether inflammation is involved
Book an appointment