ASAS 5-Question Inflammatory Back Pain Screen

For GPs assessing chronic back pain. The tool applies the ASAS 5-question inflammatory back pain screen and drafts a referral letter you can copy or send to me on WhatsApp.

For clinicians only. This tool is for healthcare professionals and clinical education only. It does not diagnose, replace clinical judgement, or replace specialist assessment. Any decisions about a patient must be based on full clinical assessment, investigations where appropriate, and current clinical guidelines.

Step 1 — Duration gate

The ASAS screen only applies when back pain has lasted more than 3 months.

Has the back pain lasted more than 3 months?

Step 2 — The five questions

1. Did the back pain start at age 40 or under?

2. Did the back pain develop gradually over time?

3. Does the back pain improve with exercise or movement?

4. Is there no improvement in the back pain with rest?

5. Is there back pain at night, especially waking in the second half of the night?

Step 3 — Referral letter details

Optional. Anything you enter is only used to draft the letter in your browser; nothing is stored.

Patient name or initials

Age

Referring doctor

Clinic or practice

Other relevant details (bloods, imaging, psoriasis, uveitis, IBD, family history)

Live result

Answer the duration question and all five questions.

Interpretation

The screen applies only to back pain lasting more than 3 months. Yes to at least 4 of the 5 questions is taken as a strong signal of inflammatory back pain and a prompt to refer for rheumatology assessment.

This is a screening and triage aid, not a diagnosis. Classification of axial spondyloarthritis still needs clinical assessment, inflammatory markers, HLA-B27 where relevant and imaging.

Sources

For clinicians only. This tool is for healthcare professionals and clinical education only. It does not diagnose, replace clinical judgement, or replace specialist assessment. Any decisions about a patient must be based on full clinical assessment, investigations where appropriate, and current clinical guidelines.

ASAS Criteria for Axial Spondyloarthritis

Imaging and clinical arms for axial spondyloarthritis classification.

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Spondyloarthritis · Classification criteria

ASAS Criteria for Peripheral Spondyloarthritis

Classification criteria for peripheral SpA when arthritis, enthesitis or dactylitis is present.

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Spondyloarthritis · Disease activity score

BASDAI

Bath Ankylosing Spondylitis Disease Activity Index across 6 patient-reported items.

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Spondyloarthritis · Functional index

BASFI

Bath Ankylosing Spondylitis Functional Index. 10 activities of daily living.

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Discuss a case with my clinic

For colleagues considering referral or shared care, please WhatsApp my clinic for professional-to-professional discussion.

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