Pre PACES Podcast #16 Back pain
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Aug 29, 2021 Dr Tom Batty, rheumatology registrar specialising in inflammatory back pain and ankylosing spondylitis. He walks through acute vs chronic approaches. They cover key differentials and red flags like cauda equina and cancer. Tom describes features of inflammatory back pain, enthesitis and extra‑articular signs. Practical exam tips, relevant investigations and management options from NSAIDs to biologics are discussed.
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Probe Red Flags For Malignancy And Fracture
- In suspected metastatic or fragility fracture look for systemic features and risk factors: weight loss, night pain, steroid use and prior fragility fractures.
- Ask about minor precipitating trauma, long-term steroids, cancers, and symptoms like night sweats or unexplained weight loss.
Ankylosing Spondylitis As An Axial Disease
- Ankylosing spondylitis (AS) sits within axial spondyloarthropathy and primarily targets sacroiliac joints and the axial spine.
- It is a seronegative inflammatory arthritis with peripheral oligoarthritis and enthesitis plus extra-articular features.
Recognize Inflammatory Back Pain Features
- Look for inflammatory back pain features: insidious onset in young people, >30–60 minutes morning stiffness, alternating buttock pain and limited spinal mobility.
- Note sacroiliac pain rarely radiates below the knee, unlike sciatica, and advanced disease causes stooped posture.