Synopsis
Recognise axial spondyloarthritis before radiographic damage, use the recommended imaging sequence, combine exercise and anti-inflammatory treatment, and escalate persistent active disease through specialist biologic pathways.
- Consider axial spondyloarthritis when chronic back pain begins before age forty-five, especially with night waking, buttock pain and improvement with movement rather than rest.
- Ask about uveitis, psoriasis, inflammatory bowel disease, enthesitis, dactylitis, peripheral arthritis and first-degree family history.
- Normal CRP, negative HLA-B27 and normal radiographs do not exclude axial spondyloarthritis.
Key red flags
Unilateral eye pain, photophobia, redness and blurred vision requires same-day ophthalmic assessment to prevent sight-threatening complications.
Investigation priorities
Identify definite structural sacroiliitis and alternative bony pathology in the NICE diagnostic sequence.
Management branches
Chronic back pain begins before forty-five with inflammatory or extra-articular features.
- Document onset, night symptoms, movement response, buttock pain, family history and psoriasis, uveitis, bowel, entheseal and peripheral-joint features.
- Refer according to NICE criteria, obtain HLA-B27 and markers when useful, and follow sacroiliac radiography then protocolled MRI when needed.
Key medicines
NaproxenCommon adult anti-inflammatory dosing is 250–500 mg orally twice daily with food, using the lowest effective dose for the shortest necessary period.
AdalimumabThe usual adult regimen for axial spondyloarthritis is 40 mg subcutaneously every other week under specialist prescribing and product information.