A case of axial undifferentiated spondyloarthritis diagnosis and management

Background A 32-year-old white man presented with features of inflammatory back pain, including awakening at night and morning stiffness. He had acute back pain 4 years earlier as a result of a herniated lumbar disc. Investigations The orthopedic consultation included tests for neurologic deficits; a Lasegue test; a finger-to-floor distance test; X-rays of the lumbar spine; and MRI of the lumbar spine. The rheumatologic consultation included recordal of clinical history and family history; physical examination, including a Schober's test, lateral spine flexion, chest expansion, cervical rotation, and tragus-to-wall distance; blood tests, including genotyping for human leukocyte antigen B27 positivity, and measurements of C-reactive protein level and erythrocyte sedimentation rate; MRI of the sacroiliac joints with use of short tau inversion recovery sequences; and measurement of the Bath Ankylosing Spondylitis Disease Activity Index and the Bath Ankylosing Spondylitis Functional Index. Diagnosis Axial undifferentiated spondyloarthritis. Management NSAIDs and physiotherapy.