Recognizing axial spondyloarthritis: a guide for primary care

Review written by Jack March info

Key Points

  1. There is an unacceptable delay to diagnosis in axial spondyloarthritis.
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Chronic back pain is an extremely common issue, affecting approximately 80-85% of the population during their lifetime and 20% of people between the ages of 20-59 at any one time. Embedded within these numbers are many different causes of symptoms. An important clinical entity that is often under-recognised is axial spondyloarthritis.

Axial spondyloarthritis (AxSpA) affects between 0.5-1.5% of the population. The predominant symptom is inflammatory back pain, so it is therefore included in the population statistics outlined above.

Unfortunately, there is a well-documented average delay to diagnosis of 8.5 years for people with AxSpA (1). There are various factors impacting this delay at different points in the patient’s diagnostic journey. Recognition and early referral in primary care is vital in order to get suspected cases into an appropriate rheumatology clinic for specialist investigations, diagnosis and early management.

This narrative review looked at journal articles related to “AxSpA”, “Inflammatory Back Pain (IBP)”, “Diagnosis” and “recognition”, with the aim of providing recommendations to primary care clinicians seeing patients with back pain to aid with appropriate onward referral.

Axial spondyloarthritis affects between 0.5-1.5% of the population.
There is no substitute for a strong knowledge base and vigilance to recognize the presentation of these conditions in the clinic environment.


There are a number of factors that affect recognition of AxSpA in primary care. All clinicians should be aware of the possibility of AxSpA being the cause of symptoms to reduce delays to diagnosis which directly impacts outcomes for these

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