Inflammatory back pain

Back pain is very common, but not all types are the same. Inflammatory back pain is different from the usual aches caused by posture or strain. It’s linked to conditions such as ankylosing spondylitis and other forms of axial spondyloarthritis, where the immune system causes inflammation in the spine and sacroiliac joints. Recognising the signs and knowing when to seek specialist care is essential for protecting long-term spine health.

What is inflammatory back pain?

Inflammatory back pain is caused by swelling in the joints and soft tissues of the spine or pelvis. It often begins gradually, particularly in younger adults, and may come and go. Over time, inflammation can lead to stiffness and damage if left untreated.

How does it differ from mechanical back pain?

Mechanical back pain, the most common type, is usually caused by muscle strain, injury or poor posture. Inflammatory back pain has different features, including:

Pain and stiffness lasting more than three months
Symptoms starting before the age of 45
Morning stiffness that improves with activity but not with rest
Pain that wakes you at night, especially in the second half of the night
Alternating buttock pain, suggesting sacroiliac joint involvement

These clues help distinguish inflammatory back pain from everyday backache.

When should you see a rheumatologist?

You should seek specialist advice if you experience:

Persistent back pain with the features listed above
Stiffness in the morning lasting longer than 30 minutes
Pain that improves with movement but worsens at rest
Family history of spondyloarthritis or related conditions such as psoriasis, uveitis or inflammatory bowel disease
New back pain with unexplained fatigue, weight loss or other systemic symptoms

A rheumatologist is trained to diagnose and treat inflammatory conditions of the spine and joints. Early referral is key to preventing long-term complications.

How is inflammatory back pain diagnosed?

Diagnosis involves a thorough clinical assessment, including questions about symptoms, medical history and lifestyle. Tests may include:

Blood tests to look for markers of inflammation or genetic links such as HLA-B27
Imaging: X-rays or MRI scans to detect early changes in the spine and sacroiliac joints
Physical examination to assess movement, flexibility and pain points

These results help confirm the diagnosis and rule out other causes of pain.

What treatments are available?

Effective treatments are available to control inflammation, relieve pain and protect spinal function:

Anti-inflammatory medications (NSAIDs) to reduce pain and stiffness
Disease-modifying therapies such as biologic injections for persistent or severe cases
Physiotherapy and tailored exercise to maintain flexibility and strengthen supporting muscles
Lifestyle measures, including good posture, regular activity and stopping smoking, to help slow progression

Why early treatment matters

Prompt diagnosis and treatment of inflammatory back pain can relieve symptoms, prevent joint damage and maintain quality of life. If you have persistent back pain with inflammatory features, seeing a rheumatologist is an important step towards effective management and long-term spinal health.