How is inflammatory back pain diagnosed?

Inflammatory back pain (IBP) is a type of chronic back pain characterized by inflammation in the spine and sacroiliac joints. Unlike mechanical back pain, which is typically caused by physical strain or injury, IBP is often linked to autoimmune conditions like ankylosing spondylitis, psoriatic arthritis, and other spondyloarthropathies.

Recognising and diagnosing IBP is crucial, as it can significantly impact a patient's quality of life and may require specific treatments that differ from those for mechanical back pain, and on hand to explain just how inflammatory back pain is typically diagnosed and managed is esteemed consultant rheumatologist, Dr Gagandeep Kaur Takhar. 

What are the symptoms of inflammatory back pain?

IBP is typically marked by pain and stiffness in the lower back and buttocks, particularly in the morning or after periods of inactivity. This stiffness usually improves with physical activity and exercise. Patients may also experience pain at night, often disrupting sleep, and symptoms can persist for more than three months.

How is inflammatory back pain diagnosed?

Diagnosis of IBP involves a combination of patient history, physical examination, and imaging studies. Key indicators include the onset of pain before the age of 40, gradual onset, improvement with exercise, and no improvement with rest. Blood tests may be conducted to check for markers of inflammation, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Imaging techniques like X-rays and MRI can reveal inflammation or structural changes in the spine and sacroiliac joints.

What are the treatment options for inflammatory back pain?

Treatment for IBP aims to reduce inflammation, alleviate pain, and improve function. Nonsteroidal anti-inflammatory drugs (NSAIDs) are often the first line of treatment, helping to manage pain and inflammation. For patients who do not respond to NSAIDs, biologic agents such as tumour necrosis factor (TNF) inhibitors, or interleukin-17 (IL-17) inhibitors may be prescribed.

Physical therapy and regular exercise are crucial components of treatment, helping to maintain mobility and reduce stiffness. In some cases, lifestyle modifications, including quitting smoking and maintaining a healthy weight, can also play a significant role in managing symptoms.

What is the prognosis for individuals with inflammatory back pain?

While IBP is a chronic condition, many patients can manage their symptoms effectively with appropriate treatment and lifestyle adjustments. Early diagnosis and intervention are key to preventing long-term damage and maintaining a good quality of life. With advancements in medical treatments, many individuals with IBP can lead active, fulfilling lives.