Inflammatory back pain is typically several years old by the time it reaches a rheumatologist, and the history that gets taken is usually of the current episode. The variable that matters is symptom duration from onset — the ASAS definition of early axial spondyloarthritis is two years or less of axial symptoms, and it is the clock that has been running unobserved.
So ask specifically: when did the back stiffness first start, not when did it become a problem. Ask about morning stiffness in the twenties, about pain that woke them in the second half of the night, about a period of physiotherapy years ago that was put down to a mechanical cause. Patients routinely date their symptoms from the point they sought help.
And write the onset date in the notes as a date. Once it exists as a number, the two-year window is either open or it is not, and the decision to escalate imaging or treatment has something to work from.
- Ask for the date of first axial symptoms, not the date of the current episode
- Probe for night pain and morning stiffness in early adulthood specifically
- Record symptom onset as a date in the notes, not as 'several years'
- HLA-B27 and inflammatory features matter more when the clock is already long
Why it matters
The definition of early disease turns on a date that is almost never recorded as one.
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