Return to Diagnosis ListShow Learning Points most relevant to Phase 1:

Inflammatory low back pain

Clinical Discipline(s)/Organ System(s)
Musculoskeletal System, Rheumatology
Progress Test Topic(s)
A 25 year old NZ European man presents to his GP with low back pain. The pain has been present for more than 18 months but increased in intensity over the last 3 months. There is pronounced early morning stiffness lasting over 2 hours and nocturnal pain such that he is awake most nights. Ibuprofen relieves his symptoms. He has a past medical history of a painful red eye on two separate occasions and bilateral Achilles tendonitis. There is no family history of arthritis, but his sister has Crohn's disease. He smokes 20 cigarettes per day and works as a forklift driver in a warehouse.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Structure, function and common pathologies of joints and ligaments including the spine
   - The role of cytokines in acute and chronic inflammation
   - Pathology of inflammatory disease of the spine and joints
   - Genetic and environmental factors contributing to ankylosing spondylitis
   - Pharmacology of analgesic medications used for back pain: paracetamol, non-steroidal anti-inflammatory medications and opioids
Clinical and Communication Skills 
   - History of inflammatory back pain in order to distinguish it from the more common non-specific mechanical low back pain
   - Focused examinations of the spine including special tests to assess ankylosing spondylitis
   - Perform a Gait-Arms-Legs-Spine (GALS) screen
   - Differential diagnosis of inflammatory back pain
   - The clinical features and complications of ankylosing spondylitis and spondyloarthropathies
   - The use of HLA-B27 genetic marker
   - The use of X-ray and MRI to investigate patients with back pain
   - Drug therapies for the management of ankylosing spondylitis and spondyloarthropathies including the role of anti-tumour necrosis factor (TNF) therapy in modifying the disease process
   - Physiotherapy and exercise therapy in ankylosing spondylitis and spondyloarthropathies
Personal and Professional Skills 
   - Recognise the need for active treatment to maintain employment
   - Ensure that there is accessible physiotherapy support close to the patient
   - Empathise with the patient's experience of living with chronic, disabling pain
Hauora Māori 
   - To consider the multidimensional nature of pain and its impact on wairua
   - Consideration of patient and family/whānau cultural and spiritual support needs
Population Health 
   - Smoking cessation
   - Epidemiology of ankylosing spondylitis and spondyloarthropathies including ethnic differences
   - Effectiveness and cost-effectiveness of anti-TNF treatments
Conditions to be considered relating to this scenario
ankylosing spondylitis, reactive arthritis, psoriatic arthritis, enteropathic arthritis (associated with inflammatory bowel disease), diffuse idiopathic skeletal hyperostosis (Forestier's disease)
Less common but 'important not to miss'
vertebral osteomyelitis, spinal malignancy, discitis, disc prolapse
spondylosis deformans, tuberculous arthritis (Pott's disease)