• Tabe Rasool Liaquat National Hospital. Karachi.
  • Tahira Perveen Umer Liaquat National Hospital & Medical College
  • Lubna Nazir Liaquat National Hospital & Medical College
  • Shafique Rehman Arain Liaquat National Hospital. Karachi.
  • Kausar Phulpoto 4th year MBBS Student Liaquat National Medical College Karachi.
  • Warda Afzal 4th year MBBS Student Liaquat National Medical College Karachi.


Background: Low back pain (LBP) is considered as one of the most frequent health problems which is responsible for forming a huge worldwide burden. This study was conducted with the aim to determine the frequency of axial-Spondyloarthropathy (axSpA) in patients presenting with chronic backache using Assessment of Spondyloarthritis International Society (ASAS) Criteria for axSpA. Methods: A total of 231 participants of either gender were enrolled with complaint of backache of more than or equal to 3 months duration and younger than 45 years. In the first stage, patients were interviewed and examined using standard questionnaire. In the second stage after going through laboratory investigations and imaging patients were classified into either axSpA (those meeting ASAS Criteria for axSpA) or non-SpA. Results: There were 65 males and 166 females. Mean age was 36.26 years. Eighty-nine (39%) patients were found to have axSpA as per ASAS Criteria. Majority of patients 70 (78.6%) in the imaging arm of ASAS Criteria were picked via MRI of sacroiliac joints. Peripheral arthritis was seen in 57 (64%) and Enthesitis in 52 (58.4%). Conclusion: MRI performed exceptionally to reveal sacroiliitis highlighting the importance of this imaging modality in axSpA, which we recommend to be included in diagnostic algorithm in evaluating patients with chronic backache under 45 years age.Keywords: Inflammatory backache; axial spondyloarthritis; Sacroiliitis;

Author Biographies

Tabe Rasool, Liaquat National Hospital. Karachi.

 Department of Rheumatology.

Tahira Perveen Umer, Liaquat National Hospital & Medical College

Department of Rheumatology.

Lubna Nazir, Liaquat National Hospital & Medical College

Department of Rheumatology.

Shafique Rehman Arain, Liaquat National Hospital. Karachi.

Department of Rheumatology.Fellow Rheumatology.

Kausar Phulpoto, 4th year MBBS Student Liaquat National Medical College Karachi.


Warda Afzal, 4th year MBBS Student Liaquat National Medical College Karachi.



Andersson GB. Epidemiology of low back pain. Acta Orthop Scand Suppl 1998;281:28–31.

Dionne CE, Dunn KM, Croft PR. Does back pain prevalence really decrease with increasing age? A systematic review. Age Ageing 2006;35(3):229–34.

Rapoport J, Jacobs P, Bell NR, Klarenbach S. Refining the measurement of the economic burden of chronic diseases in Canada. Chronic Dis Can 2004;25(1):13–21.

Kaplan W, Wirtz V, Mantel A, Béatrice PSU. Priority Medicines for Europe and the World Update 2013 report. Methodology 2013;2:7.

Hoeven L, Luime J, Han H, Vergouwe Y, Weel A. Identifying axial spondyloarthritis in Dutch primary care patients, ages 20–45 years, with chronic low back pain. Arthritis Care Res 2014;66(3):446–53.

Jois RN, Macgregor AJ, Gaffney K. Recognition of inflammatory back pain and ankylosing spondylitis in primary care. Rheumatology (Oxford) 2008;47(9):1364–6.

O’Shea FD, Boyle E, Salonen DC, Ammendolia C, Peterson C, Hsu W, et al. Inflammatory and degenerative sacroiliac joint disease in a primary back pain cohort. Arthritis Care Res (Hoboken) 2010;62(4):447–54.

Shaikh A. Ankylosing spondylitis: recent breakthroughs in diagnosis and treatment. J Can Chiropr Assoc 2007;51(4):249–60.

Rudwaleit M, Taylor WJ. Classification criteria for psoriatic arthritis and ankylosing spondylitis/ axial spondyloarthritis. Best Pract Res Clin Rheumatol 2010;5(5):589–604.

Costantino F, Talpin A, Said-Nahal R, Goldberg M, Henny J, Chiocchia G, et al. Prevalence of spondyloarthritis in reference to HLA-B27 in the French population: results of the GAZEL cohort. Ann Rheum Dis 2013;74(4):689–93.

Deyo RA, Cherkin D, Conrad D, Volinn E. Cost, controversy, crisis: low back pain and the health of the public. Annu Rev Public Health 1991;12s:141–56.

Hoy DG, March L, Brooks P, Woolf A, Blyth F, Vos T, et al. Measuring the global burden of low back pain. Best Pract Res Clin Rheumatol 2010;24(2):155–65.

Akgul O, Ozgocmen S. Classification criteria for spondyloarthropathies. World J Orthop 2011;18(12):107–15.

Feldtkeller E, Bruckel J, Khan MA. Scientific contributions of ankylosing spondylitis patient advocacy groups. Curr Opin Rheumatol 2000;12(4):239–47.

Helmick CG, Felson DT, Lawrence RC, Gabriel S, Hirsch R, Kwoh CK, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part I. Arthritis Rheum 2008;58(1):15–25.

De Angelis R, Salalfi F, Grassi W. Prevalence of spondyloarthropathies in an Italian population sample: a regional community-based study. Scand J Rheumatol 2007;36(1):14–21.

Rudwaleit M, Landewe R, van der Heijde D, Listing J, Brandt J, Braun J, et al. The development of assessment of spondyloarthritis international society classification criteria for axial spondyloarthritis (part I): classification of paper patients by expert opinion including uncertainty appraisal. Ann Rheum Dis 2009;68(6):770–6.

Rudwaleit M, van der Heijde D, Landewe´ R. The development of assessment of spondyloarthritis international society classification criteria for axial spondyloarthritis (part II): validation and final section. Ann Rheum Dis 2009;68(6):777–83.

Sieper J, Rudwaleit M, Baraliakos X, Brandt J, Braun J, Burgos-VargasR, et al. The assessment of spondyloarthritis international society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis 2009;68:ii1–44.

Sieper J, Braun J. How important is early therapy in axial spondyloarthritis? Rheum Dis Clin North Am 2012;38(3):635–42.

Poddubnyy D, Vahldiek J, Spiller I, Buss B, Listing J, Rudwaleit M, et al. Evaluation of 2 screening strategies for early identification of patients with axial spondyloarthritis in primary care. J Rheumatol 2011;38(11):2452–60.

van der Heijde D, Sieper J, Elewaut D, Deodhar A, Pangan AL, Dorr AP. Referral patterns, diagnosis, and disease management of patients with axial spondyloarthritis: results of an international survey. J Clin Rheumatol 2014;20(8):411–7.

Brandt HC, Spiller I, Song IH, Vahldiek JL, Rudwaleit M, Sieper J. Performance of referral recommendations in patients with chronic back pain and suspected axial spondyloarthritis. Ann Rheum Dis 2007;66(11):1479–84.

Sieper J, Rudwaleit M. Early referral recommendations for ankylosing spondylitis (including pre-radiographic and radiographic forms) in primary care. Ann Rheum Dis 2005;64(5):659–63.

Tant L, Delmotte N, Van den Enden M, Gangji V, Mielants H. High Prevalence of Undiagnosed Axial Spondyloarthritis in Patients with Chronic Low Back Pain Consulting Non-Rheumatologist Specialists in Belgium: SUSPECT Study. Rheumatol Ther 2017;4(1):121–32.

Deodhar A, Mease PJ, Reveille JD, Curtis JR, Chen S, Malhotra K, et al. Frequency of axial spondyloarthritis diagnosis among patients seen by US rheumatologists for evaluation of chronic back pain. Arthritis Rheumatol 2016;68(7):1669–76.

Burgos-Vargas R, Wei JC, Rahman MU, Akkoc N, Haq SA, Hammoudeh M, et al. The prevalence and clinical characteristics of nonradiographic axial spondyloarthritis among patients with inflammatory back pain in rheumatology practices: a multinational, multicenter study. Arthritis Res Ther 2016;18(1):132.

Poddubnyy D, Brandt H, Vahldiek J, Spiller I, Song IH, Rudwaleit M, et al. The frequency of non-radiographic axial spondyloarthritis in relation to symptom duration in patients referred because of chronic back pain: results from the Berlin early spondyloarthritis clinic. Ann Rheum Dis 2012;71(12):1998–2001.

Sieper J, van der Heijde D, Dougados M, Mease PJ, Maksymowych WP, Brown MA, et al. Efficacy and safety of adalimumab in patients with non-radiographic axial spondyloarthritis: results of a randomised placebo-controlled trial (ABILITY-1). Ann Rheum Dis 2013;72(6):815–22.

Kiltz U, Baraliakos X, Karakostas P, Igelmann M, Kalthoff L, Klink C, et al. The degree of spinal inflammation is similar in patients with axial spondyloarthritis who report high or low levels of disease activity: a cohort study. Ann Rheum Dis 2012;71(7):1207–11.

Wallis D, Inman RD. Recognition of preclinical and early disease in axial spondyloarthritis. Rheum Dis Clin North Am 2014;40(4):685–97.

Rudwaleit M, Khan MA, Sieper J. The challenge of diagnosis and classification in early ankylosing spondylitis: do we need new criteria? Arthritis Rheum 2005;52(4):1000–8.