When should patients see a rheumatologist for chronic back pain?

by Rachel Martin, Yale School of Medicine

edited by Lisa Lock, reviewed by Andrew Zinin

Lisa Lock

Scientific Editor

Meet our editorial team
Behind our editorial process

Andrew Zinin

Chief Editor

Meet our editorial team
Behind our editorial process Editors' notes

This article has been reviewed according to Science X's editorial process and policies. Editors have highlighted the following attributes while ensuring the content's credibility:

fact-checked

trusted source

proofread

The GIST Add as preferred source

Axial spondyloarthritis (axSpA) is an inflammatory condition that causes chronic back pain and, if left untreated, can lead to fusion of the spinal or sacroiliac joints. The condition frequently remains underdiagnosed, with some studies suggesting that diagnosis can be delayed by up to 14 years. A new set of recommendations published in ACR Open Rheumatology aims to help improve the diagnosis of axSpA.

"Most of the people with this condition are young folks at the peak of their careers and family life. It's an important stage of life where an accurate diagnosis and treatment can make a difference in their immediate situation and the trajectory of their lives," says Abhijeet Danve, MBBS, MD, associate professor of medicine (rheumatology, allergy & immunology) and first author of the study.

In a Q&A, Danve discusses why axSpA is so underdiagnosed and how he hopes these recommendations will improve the outlook for people with the condition.

Why is axSpA underdiagnosed?

There are a few reasons for this. The way we understand axSpA has changed dramatically over the past few decades. We used to think it was a rare disease, and it was believed to primarily affect men. Now we know that it's relatively common and that women are just as likely to have this condition as men.

Second, axSpA is difficult to diagnose. There is no specific blood test that can diagnose this condition. AxSpA primarily causes inflammation in the spine and sacroiliac joints—two locations that are nearly impossible to examine for inflammation. Even if a doctor orders an X-ray of the sacroiliac joints, they may not see anything abnormal because, on average, it takes eight years for an X-ray to show abnormalities.

Finally, the symptoms of this condition are nonspecific. Back pain, the main symptom of axSpA, is very common in the general population, and only 5% of patients with back pain have axSpA. Symptoms also include tendinitis, eye inflammation (uveitis), psoriasis, inflammatory bowel disease or a family history of similar conditions. It can be challenging because most people will see different specialists for each condition. It is hard for one person to really put this all together.

Rheumatologists have the training and skill set to take a very thorough history and connect the dots among these seemingly unrelated symptoms.

Tell me about the new recommendations.

Nearly 1 in 5 U.S. adults has chronic back pain, and the pain can be attributed to many different conditions, many of which are not related to rheumatologic conditions.

The challenge is, how should we decide which back pain patients should be referred to a rheumatologist?

Our goal was to create feasible, simple and practical recommendations that primary care providers and other clinicians could use in their daily practice to help determine whether a particular patient should be referred to rheumatology. These recommendations were developed on behalf of the Spondyloarthritis Research and Treatment Network (SPARTAN).

To achieve this, we convened a large group of experts, including rheumatologists, ophthalmologists, gastroenterologists, patients and other specialists treating back pain conditions, to compile a comprehensive list of characteristics associated with axSpA. Looking at past studies, we selected the 10 items that we agreed were most relevant and then weighted each item to develop a simple scoring system. The scoring system was designed so that, on average, rheumatologists will diagnose one patient with axSpA for every three individuals referred to them for screening for the condition.

Why is now the right time to develop and publish these recommendations?

The field recently updated our guidance around diagnosing people with axSpA. We used to require evidence of damage on the X-ray, but our new understanding allows us to diagnose people in their first two or three years with the help of MRI, before they have visible damage. This means we have a much bigger window to treat people and slow disease progression.

We also now have a wide range of medications available to treat the condition. Until about 15 years ago, we could diagnose patients but had very limited therapies to offer them. Now, we have 10 different medications, giving us a lot of options to help people feel better. Newer therapies not only improve symptoms and inflammation but may also prevent fusion of the spine.

What's next for your work in this area?

Going forward, we hope these recommendations can be validated in a prospective study. We want to understand whether this guidance actually changes diagnosis rates across the population. I also hope that health systems begin to embed these recommendations in their electronic health record systems in the form of an online calculator.

In addition, we developed a free, online patient screening tool that individuals can use to determine if they should see a rheumatologist for their chronic back pain.

Through this work, I am hopeful that we can provide more patients with an accurate diagnosis and appropriate treatment to make a meaningful difference in their lives.

More information

Maureen Dubreuil et al, Spondyloarthritis Research and Treatment Network Recommendations for the Referral of Adults With Chronic Back Pain and Suspected Axial Spondyloarthritis to a Rheumatologist, ACR Open Rheumatology (2026). DOI: 10.1002/acr2.90129

Key medical concepts

Spinal FusionMagnetic Resonance ImagingUveitis

Clinical categories

RheumatologyCommon illnesses & Prevention Provided by Yale School of Medicine Who's behind this story?

Lisa Lock

BA art history, MA material culture. Former museum editor, paramedic, and transplant coordinator. Editing for Science X since 2021. Full profile →

Andrew Zinin

Master's in physics with research experience. Long-time science news enthusiast. Plays key role in Science X's editorial success. Full profile →

Citation: When should patients see a rheumatologist for chronic back pain? (2026, September 10) retrieved 10 September 2026 from https://medicalxpress.com/news/2026-09-patients-rheumatologist-chronic-pain.html This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.