AxSpA commonly presents with persistent back/buttock/hip pains that begin before age of 45 years. Back pain is typically worse in the morning and is associated with morning stiffness for more than 30 minutes. It is called inflammatory back pain (See below for more details). Over time, ongoing inflammation may affect spinal flexibility and posture and at its worst cause fusion of the spine or SI joints. Frequently patients can develop inflammation of tendon ends called enthesitis, particularly heel pain (plantar fasciitis or Achilles tendonitis), tennis elbow or rib cage pains. Some patients experience pain and swelling of other joints like ankles or knees. Either patients or their family members can have skin psoriasis, Crohn’s disease, ulcerative colitis or inflammatory eye condition called iritis or uveitis. Blood tests called CRP and HLA-B27 are helpful but not confirmatory. X-ray or MRI of SI joints can be very helpful to confirm the diagnosis.