Simple Screening Tool Can Help Uncover Underdiagnosed Back Condition, Study Finds

For millions of people living with back pain, the cause is often elusive. One underrecognized culprit is axial spondyloarthritis (axSpA)—a form of inflammatory arthritis that primarily affects the spine and sacroiliac joints of the hips. Left undiagnosed, axSpA can lead to chronic back pain, stiffness, reduced mobility, and diminished quality of life. On average, patients may suffer pain for eight to twelve years before receiving the correct diagnosis.

“This type of diagnostic delay is unacceptable in the current day and age,” says Yale School of Medicine’s Abhijeet Danve, MD, MHS. “We do have medications to treat this condition effectively, but patients are often diagnosed late—or never diagnosed at all.”

Danve and colleagues are working to change that. Their new study, published in Rheumatology Advances in Practice, tested an innovative online screening questionnaire—known as the A-tool—to help identify people who may have axSpA and guide them to the right care more quickly.

Unlike previously proposed screening methods and referral strategies, which often require specialized imaging or blood tests, the A-tool consists of a brief set of clinical questions. Patients can complete it themselves, without a physician intermediary. Distributed through electronic health record portals and Facebook in the study, the tool quickly reached more than 1,200 patients who reported chronic back pain. Among the 100 participants who were fully evaluated, about one in three were diagnosed with axSpA.

The simplicity, practicality, and feasibility of the A-tool are its strengths, the researchers say. By cutting through the complexity of diagnosing back pain, it improves the odds of flagging patients for timely referral to a rheumatologist. “Our tool increases the probability of detection from 5% to 33%, which is a huge improvement,” says Danve, an associate professor of medicine (rheumatology, allergy, and immunology).

For patients, the message is clear: persistent back pain—especially in younger adults—shouldn’t be ignored. Early recognition can open the door to effective treatment, including biologic therapies that improve function and quality of life.

“The results of this work can help identify individuals who potentially have low back pain due to axial spondylarthritis, which can be treated with appropriate medications,” says co-author Insoo Kang, MD, professor of medicine (rheumatology, allergy, and immunology).

Danve hopes to refine the A-tool further by modifying the questionnaire and creating an online calculator that is accessible to anyone. His broader goal is patient empowerment toward early diagnosis and effective treatment.

“Patients are their own best advocates,” Danve says. “By giving them the means to spot warning signs sooner, this research could help shorten the road to diagnosis and bring relief to many living with back pain.”

Rheumatology, Allergy, and Immunology, one of 10 sections in the Yale Department of Internal Medicine, is dedicated to providing care for patients with rheumatic, allergic and immunologic disorders; educating future generations of thought leaders in the field; and researching fundamental questions of autoimmunity and immunology. To learn more, visit Rheumatology, Allergy and Immunology.