Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, PO Box 100154, Gainesville, FL 32610-0154, USA.
Phys Ther. 2010 May;90(5):784-92. doi: 10.2522/ptj.20090172. Epub 2010 Mar 18.
Patients with inflammatory spinal conditions related to spondyloarthritis are rarely seen by primary care practitioners. However, patients with a history of inflammatory bowel disease and chronic low back or buttock pain should be examined carefully for the presence of spondyloarthritis, as proper management may include referral to a rheumatologist and appropriate medical intervention.
A 27-year-old woman with a 6-month history of posterior buttock pain was referred for physical therapy with a diagnosis of piriformis syndrome. During the second physical therapy visit, a nonmechanical source of lumbopelvic pain was suspected, and the patient was referred for medical consultation. The patient underwent evaluation by a rheumatologist and was eventually diagnosed with spondyloarthritis associated with inflammatory bowel disease.
The patient initiated treatment with anti-tumor necrosis factor medication to address the spondyloarthritis. Medical management resulted in significant improvement in all outcome measures.
Clinical suspicion of spondyloarthritis is raised when specific historical, examination, and imaging findings are present. The posttest probability of spondyloarthritis is increased with the presence of inflammatory back pain and specific spondyloarthritic features, such as a positive history of inflammatory bowel disease, radiographic evidence of sacroiliitis, and improvement with anti-inflammatory medication. Referral of patients with these findings for a rheumatological evaluation is warranted, as these diseases are managed effectively with specific treatment.
患有与脊柱关节炎相关的炎症性脊柱疾病的患者很少由初级保健医生诊治。然而，有炎症性肠病和慢性下背部或臀部疼痛病史的患者应仔细检查是否存在脊柱关节炎，因为适当的治疗可能包括转介给风湿病专家和进行适当的医学干预。
一名 27 岁女性，有 6 个月的臀部后侧疼痛史，被诊断为梨状肌综合征并接受物理治疗。在第二次物理治疗就诊时，怀疑存在非机械性腰骶部疼痛源，因此患者被转诊接受医学咨询。患者接受了风湿病专家的评估，最终被诊断为与炎症性肠病相关的脊柱关节炎。
患者开始接受抗肿瘤坏死因子药物治疗以治疗脊柱关节炎。医学治疗导致所有结局指标均显著改善。
当存在特定的病史、检查和影像学发现时，会引起对脊柱关节炎的临床怀疑。存在炎症性背痛和特定的脊柱关节炎特征（如炎症性肠病史阳性、骶髂关节炎的放射学证据以及抗炎药物治疗有效）会增加脊柱关节炎的后验概率。对于存在这些发现的患者，应进行风湿病学评估，因为这些疾病可以通过特定的治疗方法有效治疗。
