Refer patients with low back pain that started before the age of 45 years and has lasted for longer than 3 months, and if 4 or more of the following additional criteria are also present:
- low back pain that started before the age of 35 years (this further increases likelihood of axial spondyloarthritis),
- waking during second half of the night, because of symptoms,
- buttock pain,
- improvement with movement,
- improvement with taking non-steroidal anti-inflammatory drugs (often within 48 hours),
- a first-degree relative with spondyloarthritis,
- current or past arthritis,
- current or past enthesitis,
- current or past psoriasis.
If exactly 3 of the additional criteria are present, perform an HLA‑B27 test. If the test is positive, refer the person to a rheumatologist for a spondyloarthritis assessment.
When screening criteria are not met but clinical suspicion remains, advice the person to seek repeat assessment if new signs, symptoms or risk factors develop. This may be particularly appropriate if the person has or had psoriasis, inflammatory bowel disease or uveitis.