Axial spondyloarthritis (
AxSpA) is a chronic inflammatory
rheumatic disease characterized by inflammatory
back pain (
IBP) that manifests in childhood, late adolescence, or early adulthood.
Ankylosing spondylitis (AS) and nonradiographic
AxSpA represent 2 ends of the
AxSpA spectrum. Diagnosis can be challenging because patients develop
IBP that may not be associated with radiographic changes in the sacroiliac joints. Patients early in the course of disease are estimated to have at least the same level of disease activity and
pain as patients with established disease; thus, they could benefit substantially from earlier diagnosis. Although the recent use of magnetic resonance imaging and its inclusion in diagnostic criteria has enhanced the identification of early
AxSpA, improvement in early diagnosis has not been consistently reported across all studies. Limited knowledge of the continuum of
AxSpA disease manifestations and lack of recognition of
IBP in primary practice may contribute to this. Implementing a referral strategy that identifies patients with
IBP for additional testing and assessment may lead to better recognition of early signs and symptoms of
AxSpA, thereby offering the potential for improved patient outcomes. This review presents an overview of the epidemiology, clinical characteristics, and burdens of
AxSpA, followed by a case presentation outlining approaches to the evaluation and management of a patient with suspected inflammatory spine disease.