by David Borenstein, MD Executive EditorTheSpineCommunity.com12/2020

Ankylosing spondylitis (AS) is an inflammatory spinal disease which is associated with variety of symptoms including morning stiffness, fatigue, and limited spine motion. The classic diagnosis of AS includes radiographic evidence of inflammation in the sacroiliac joints (sacroiliitis). Prior to the Xray changes, inflammation affects the sacroiliac joints that may be discovered only on magnetic resonance imaging (MRI) evaluation of the pelvis. The presence of inflammation solely identified by MRI testing makes the diagnosis of nr-axSpA even more difficult than AS. Of continued interest is the question of whether nr-axSpA is the early stage of AS or a separate illness. Look at posts on the Spine Community for additional information about nr-axSpA.

In the US, a delay in diagnosis of nr-axSpA may be as long as 14 years. A study at the ACR Convergence meeting looked at the factors contributing to a diagnostic delay. The study recruited 125 nr-axSpA patient who had more than 3 months of chronic back pain starting before age 45. The average age of the 125 patients was 43.5 years, female 74%, Caucasian 84%, Latin X 3%, Africa-American 2%. About 50 % saw 4 doctors before seeing a rheumatologist, and 50 % saw 2 rheumatologists before the diagnosis was made. The interval between the onset of symptos and diagnosis ranged between 40% in less than 2 years, and 25% greater than 11 years. Many individuals thought their back pain as a consequence of activity or age. When individuals did seek medical care, their symptoms wire minimized, overlooked, or misinterpreted particularly in young females. Many physicians and other health care professionals (primary care, orthopedists, chiropractors, osteopaths, nurse practitioners) are unaware of the diagnosis. Even some rheumatologists are not fully aware of the existence of this entity. It is important for individuals, particularly young females, to not pass off their symptoms of chronic low back pain. They should be sure to find a rheumatologist who is aware of nr-axSpA so an appropriate diagnosis can be made.


  1. Kiwalkar S et al. “Rheum to Diagnosis”: Uncovering impediments to accurate diagnosis of Non-radiographic Axial Spondyarthritis (nr-axSpA. ACE Convergence 2020 Abstract 1869

David Borenstein, MD
Executive Editor