Leyla Bagheri - Department of Internal Medicine, Shahid Modarres Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran
Maryam Fakhri - School of medicine, Tehran University of Medical Science, Tehran, Iran Department of Internal Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Science, Tehran, Iran
fatemeh Rashidi - School of medicine, Tehran University of Medical Science, Tehran, Iran
Shila Aghayani - Department of Rheumatology,Imam khomeini hospital,Tehran university of medical sciences tehran , Iran

Axial spondyloarthritis (axSpA) represents a chronic inflammatory condition primarily impacting axial joints, characterized by sacroiliitis and spondylitis. In axSpA patients, low back pain (LBP) typically assumes a chronic and inflammatory nature, where diagnostic delays can precipitate disability. However, atypical axSpA presentations pose challenges for early diagnosis and management. In the current study, we detail the case of a ۳۹-year-old male presenting with acute, severe LBP and bilateral sacroiliitis. Initial treatment with non-steroidal anti-inflammatory drugs (NSAIDs), the standard first-line therapy, was discontinued due to severe gastrointestinal bleeding. Following a bone biopsy that excluded alternative etiologies, axSpA was confirmed based on diagnostic criteria. Elevated inflammatory markers, contraindications to NSAIDs, and magnetic resonance imaging findings prompted the initiation of anti-tumor necrosis factor (TNF) therapy. Remarkably, a marked improvement was observed in less than six weeks post anti-TNF therapy commencement. This case underscores the significance of recognizing atypical axSpA presentations and underscores the potential for swift and robust responses to anti-TNF agents. Optimal patient outcomes hinge upon effective disease pattern recognition and treatment selection.

ankylosing spondylitis, axial spondyloarthritis, acute low back pain, anti-TNF, adalimumab