ACR Appropriateness Criteria® Inflammatory Back Pain: Known or Suspected Axial Spondyloarthritis: 2021 Update

J Am Coll Radiol. 2021 Nov;18(11S):S340-S360. doi: 10.1016/j.jacr.2021.08.003.


Inflammatory back pain is a hallmark feature of axial spondyloarthritis, a heterogeneous group of inflammatory disorders which affects the sacroiliac joints and spine. Imaging plays a key role in diagnosis of this disease and in facilitating appropriate treatment. This document provides evidence-based recommendations on the appropriate use of imaging studies during multiple stages of the clinical evaluation of patients with suspected or known axial spondyloarthritis. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Keywords: AUC; Ankylosing spondylitis; Appropriate Use Criteria; Appropriateness Criteria; Arthritis; Axial spondyloarthritis; Inflammatory back pain; Sacroiliac joints; Spine.

Publication types

  • Practice Guideline

MeSH terms

  • Axial Spondyloarthritis*
  • Back Pain / diagnostic imaging
  • Chronic Pain*
  • Humans
  • Societies, Medical
  • Spine
  • United States