Patients with axSpA typically present with chronic back pain. They often seek care from their primary care providers but are also commonly managed by chiropractors, physiatrists, orthopedists, pain specialists, physical therapists, and other HCPs. Some axSpA patients have prominent extra-spinal manifestations (e.g. uveitis, inflammatory bowel disease, psoriasis) and receive care in ophthalmology and gastroenterology clinics. In order to facilitate the assessment of patients who may have axSpA by a rheumatologist, it is essential for providers with these diverse backgrounds to be sufficiently familiar with axSpA and to know if and when to refer.

Unfortunately, existing data suggest that non-rheumatologist clinicians who manage patients with back pain often do not have adequate knowledge of axSpA including its typical symptoms, spectrum of disease, and epidemiology.

A recent survey amongst 1650 HCPs from 10 specialties analyzed barriers to rheumatology referral for possible axSpA. Rather than considering the diagnosis of axSpA, HCPs were more likely to order rheumatoid factor (RF) and anti-nuclear antibody (ANA) tests for chronic back pain, despite the low probability of rheumatoid arthritis or lupus in this setting. However, 62.3% of the surveyed HCPs wanted to learn more about the clinical course of axSpA, 58.8% wanted more information on clinical evaluation, and 50.3% indicated that education about new and emerging treatments would be helpful.


Dr. Dax G. Rumsey, MD, MSc, FRCP(C

Dr. Dax G. Rumsey, MD, MSc, FRCP(C) is a mid-career pediatric rheumatologist working at the University of Alberta and Stollery Children’s Hospital in Edmonton, Alberta.  His main clinical and research interest is in the area of juvenile spondyloarthritis.  He is a member of the Spondyloarthritis Research and Treatment Network (SPARTAN), a network of North American health care professionals with a special interest in spondyloarthritis.  He is also the chair of the Early Identification and Diagnosis of Axial Spondyloarthritis (EIDA) program, an educational initiative aimed at educating non-rheumatologists about this disease, with the goal of earlier diagnosis, earlier treatment, and improved outcomes.

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