Health History and Physical Exam to Diagnose AxSpA

Reviewed by: HU Medical Review Board | Last reviewed: May 2020 | Last updated: March 2021

A diagnosis of a condition on the AxSpA spectrum involves an eclectic approach. Diagnosing conditions on the AxSpA spectrum can be difficult, since many of the symptoms can also be symptoms of other conditions. Especially if nothing shows up on imaging tests, doctors may not realize that the symptoms are indicative of certain conditions. This is why a thorough medical history is important, along with a physical examination.

Even without any evidence on imaging tests, you can still be diagnosed with a condition on the AxSpA spectrum based on a pattern of symptoms.

There are a variety of classification criteria and disease activity scales that can be applied to give a provider a better clinical picture of your symptoms and evaluate the disease activity. Talk with your doctor about the criteria they are using to diagnose you, and where your symptoms fit in the larger picture.

Taking a medical history for diagnosing axial spondyloarthritis

Your doctor will take a medical history from you and ask you about any symptoms you may be having. Be honest and open with your doctor; no symptom is too small. By giving as much information as possible, you’ll be able to help them make an accurate diagnosis. The doctor should also ask about family history of AxSpA spectrum conditions. Family members of people with these conditions are more likely to be at risk of developing these conditions than those with no family history.1

Physical examination for diagnosing axial spondyloarthritis

A general physical examination should also be done, especially to rule out any conditions that are not on the AxSpA spectrum. Spinal mobility can be assessed using certain physical examination techniques.2 An examination will also give the doctor an idea of any joint inflammation or mobility impairment, any comorbid conditions that may be present, and a larger overall picture of your health.

ASAS classification criteria

The Assessment of SpondyloArthritis International Society (ASAS) developed, validated, and refined criteria for the classification and diagnosis of AxSpA. The criteria were based on people who had chronic back pain for more than 3 months of unknown origin before age 45.3 The final criteria developed are below:3

BASFI (Bath Ankylosing Spondylitis Functional Index)

The Bath Ankylosing Spondylitis Functional Index, or BASFI, is a test that measures disease activity and function in people with ankylosing spondylitis (AS). It is a self-report, meaning the person with AS fills it out themselves. It asks questions about symptoms related to AS. Since it is particular to AS, a person with nr-AxSpA can fill it out, but the results may not accurately reflect functioning or disease activity.4 It is most accurate for someone with AS.

BASDAI (Bath Ankylosing Spondylitis Disease Activity Index)

The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was developed by a multidisciplinary team and involves a numeric scale to rate various symptoms of AS like spinal and peripheral joint pain, fatigue, and morning stiffness.5 It is often used to evaluate treatment for AS to see if it is effective in controlling the condition. The test has been found to be reliable and valid, and sensitive to change, which makes it a good test for monitoring treatment effectiveness and disease activity. Again, this has been found to be most appropriate for those with AS, and not other conditions on the AxSpA spectrum.4

While indices and rating scales are fine, a diagnosis of an AxSpA spectrum condition is often made through history and physical examination, and if need be, other tests that are ordered. History and examination are key to diagnosing any condition. The clinical pattern of a condition can tell a doctor a lot, even in the presence of normal results on imaging and lab tests.

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