Inflammatory Back Disease

Patients who may have inflammatory back disease can be referred directly to, and followed up by our specialist clinic, which is run jointly with our rheumatology physiotherapist.

Who is referred for this service?

Patients who present to their GPs with symptoms suggestive of inflammatory back disease. There is a referral pathway for reference for the GPs.

All referrals are triaged by the consultants and prioritised according to clinical need.


Most Rheumatology referrals are seen in Royal Surrey County Hospital, Outpatients 4, or less commonly in a peripheral hospital that should have access to bloods and XRs on site.

If you are not seen at the Royal Surrey County Hospital, you may have to attend at a later date to have investigations (such as MRIs, USS, DEXA)  before a diagnosis will be made.

What should I expect on the first appointment?

The majority of new patient appointments will be face-to-face. In addition to your face-to-face appointment, you may be sent for other investigations. These may include blood tests, X-rays and possibly an urgent Ultrasound scan, ideally all on the day of your attendance, or if not, within a few days.

Be prepared to spend some hours in the hospital getting these tests done.

You may need investigations for which there is a wait - in this case you will have to attend at a later date.

I haven't had my appointment yet and i've been asked to attend an MRI - why?

An MRI scan is a very sensitive way to diagnose inflammatory back disease. If the triaging consultant deems it appropriate, depending on your previous investigations and your GP’s letter, an MRI scan may be arranged in advance of your clinic appointment.

Will I start treatment immediately?

You are very likely to be referred for physiotherapy. You may be started on an NSAID (non-steroidal anti inflammatory drug). If you are already taking this sort of medication, you may be switched to a different NSAID. You may be considered for other medications - these are unlikely to be started at the first appointment.

What sort of follow up should I expect?

Patients who have mechanical rather than inflammatory back disease do not require follow up after their first appointment. In some cases, you may be sent for an investigation (such as an MRI), and will then receive the results via a letter from the doctor who organised the investigation.

If mechanical disease is confirmed, then referral to physiotherapy and/or the Pain Team may be considered.

If inflammatory back disease is confirmed, then you are likely to be referred to physiotherapy and followed up in the clinic. You may be seen by a rheumatology physiotherapist in clinic or a doctor - our physiotherapist works closely with the medical team for this group of patients.

How do I get the results of my investigation?

If you’ve been sent for an investigation, such as an MRI, a CT, or an ultrasound, then you would usually be sent a letter with the results, and any appropriate change in your management plan, once the results have made their way back to your consultant.

If you had your investigation more than six weeks ago, and you haven’t heard anything, then contact the department, and the results will be chased up and sent to you.

Will I receive a letter after my treatment?

You will receive a copy of your clinic letter. This is written to your GP, rather than to you, so the langauge used will be more medical and specific, so don't be alarmed if it seems confusing. You can ask your GP any questions you may have. 

Who do I contact if there's an issue with my appointment?

The secretaries and CNS team are not able to book appointments for you. If you wish to change the date of your appointment, or haven’t heard about an expected appointment, please contact the Appointment Centre on 01483 464002 or email

Where do I find more information about my condition and medication?

The ‘Versus Arthritis’ website has excellent patient information leaflets on the majority of rheumatic conditions and drugs:

There are also national and local support groups for many rheumatic diseases. You can find links for support groups here.