What could be the reason for lower back pain and joint stiffness?

Question

Hello doctor,

My aunt is a 50-year-old female patient, who experiences chronic lower back pain, stiffness in the morning lasting over an hour, and occasional swelling in peripheral joints. She is concerned about the possibility of non-radiographic axial spondyloarthritis but is confused about the diagnosis due to normal X-ray findings. How can advanced imaging techniques like MRI, along with clinical markers such as HLA-B27 status and CRP levels, help confirm or rule out the diagnosis?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Your aunt’s symptoms, like chronic lower back pain, significant morning stiffness lasting over an hour, and occasional peripheral joint swelling, are suggestive of non-radiographic axial spondyloarthritis (nr-axSpA). Non-radiographic axial spondyloarthritis lacks visible structural changes on X-rays but is characterized by inflammation detectable through advanced diagnostics.

A physical examination by a rheumatologist in a hospital is essential to confirm the diagnosis.

MRI (magnetic resonance imaging) is the gold standard in evaluating early inflammatory changes in nr-axSpA, particularly when X-rays are inconclusive. It can detect bone marrow edema, an indicator of active inflammation, erosions, or fat deposits.

Testing for the HLA-B27 (human leukocyte antigen) gene, as it is strongly associated with spondyloarthritis. A positive HLA-B27 result increases the likelihood of nr-axSpA when combined with inflammatory back pain, morning stiffness, and peripheral joint involvement. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are often elevated in nr-axSpA, reflecting systemic inflammation.

Must rule out mechanical lower back pain, degenerative disc disease, or fibromyalgia. Features like pain that improves with exercise but worsens with rest, nocturnal pain, and alternating buttock pain are indicators of inflammatory rather than mechanical back pain.

Treatment includes -

Non-steroidal anti-inflammatory drugs (NSAIDs) to control pain and stiffness.
Biologic therapies.

Lifestyle changes include

Regular exercise.
Good posture.
Avoid smoking.

Get well soon. Feel free to follow up with any questions or updates.

I hope this helps.

Thank you, and take care.

Regards.