eISSN: 2449-8580
ISSN: 1734-3402
Family Medicine & Primary Care Review
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3/2016
vol. 18
 
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abstract:

Inflammatory low back pain: diagnostic and therapeutical recommendations for family doctors

Eugeniusz Józef Kucharz
1
,
Agnieszka Mastalerz-Migas
2
,
Brygida Kwiatkowska
3
,
Robert Gasik
4
,
Anna Kotulska
1
,
Jacek Kowalczewski
5
,
Tomasz Tomasik
6

  1. Chair and Department of Internal Medicine and Rheumatology, Medical University of Silesia in Katowice
  2. Chair and Department of Family Medicine, Medical University of Wroclaw
  3. Department of Early Arthritis of the National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw
  4. Department of Neuroorthopedics and Reumoorthopedics of the National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw
  5. Department of Orthopaedics and Reumoorthopedics of the Postgraduate Medical Centre in Otwock
  6. Department of Family Medicine, Department of Internal Medicine and Gerontology, Jagiellonian University Medical College in Krakow
Family Medicine & Primary Care Review 2016; 18, 3: 399–407
DOI: https://doi.org/10.5114/fmpcr/64779
Online publish date: 2016/09/27
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Low back pain (LBP) or pain of the lumbo-sacral region of the vertebral column is a polyetiological clinical state. LBP is a common medical condition and has a recurrent nature. The incidence of the first LBP episode in life varies from 6.3 to 15.4% a year, while the total annual LBP incidence is estimated at up to 36%. The cause of LBP can be located in the osseous structures and the joints of the vertebral column, the intervertebral discs, as well as the muscles, ligaments and nerves of the lumbo-sacral region. Commonly, the disease mechanism is complex. Differential diagnosis is an important part of the management

of LBP patients due to a number of potential causes. Some forms of LBP need emergency management, and their features are known as “red flag symptoms”. Such LBP forms occur at night and lack any connection with physical activity (especially in the early stage of the disease). Rapidly deteriorating LBP also needs to be considered as an emergency. Inflammatory LBP occurs in patients with inflammatory spondyloarthropathies (in 70–80% of the patients). The presented recommendations are designed to facilitate the identification of patients with inflammatory LBP. They also describe rules of referring to a rheumatologist,

as well as focus on the cooperation of a family doctor and a rheumatologist in the treatment of these patients. In most patients LBP is the first symptom of inflammatory spondyloartropathy. The classification criteria of inflammatory LBP are as follows: 1) onset at the age below 40; 2) insidious onset; 3) an improvement after physical exercise; 4) the lack of improvement after rest; 5) pain at night with improvement after getting up from bed. Non-pharmacological (kinesiotherapy, patient education) and pharmacological methods (non-steroidal anti-inflammatory drugs, TNF -alpha blockers) are used in the management

of patients with inflammatory spondyloartropathy.
keywords:

low back pain, red flag symptoms, inflammatory spondyloarthropaties

  
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