Low back pain may have different concerns for doctors in different departments. Doctors in spine surgery will focus more on disc lesions and trauma, etc. Neurologists focus more on the spinal cord and nerves, and some doctors who encounter low back pain will habitually think of ankylosing spondylitis. However, as a rheumatologist, when you encounter a patient with low back pain, you need to analyze the patient’s condition comprehensively, otherwise you may miss or misdiagnose the condition. What are the diseases that present with low back pain? Both doctors and patients should pay attention to the following diseases may: (a) spine and paraspinal soft tissue diseases 1, injury: ① acute injury: acute lumbar sprain, spinal fracture dislocation, acute disc prolapse, small joint synovial impaction, paraspinal soft tissue injury, etc.; ② chronic injury: chronic lumbar strain, arch isthmus crack and slippage, disc herniation, supraspinal interspinous ligament injury, myofascial chronic strain (myofascial pain syndrome Myofascial pain syndrome, myofibrositis, sacroiliac joint strain, etc. Comments: The doctor can roughly determine the possibility of this type of disease through questioning and physical examination, which can be determined through further examination. 2, spinal inflammation: ① septic: septic spondylitis, epidural abscess, arachnoiditis; ② non-septic: spinal arthritis (including ankylosing spondylitis); ③ specific infection: spinal tuberculosis, etc. Point:The appearance of low back pain should think more about some possibilities, septic may appear fever, or even hyperthermia; spinal arthritis insidious onset, rarely hyperthermia, more activity to reduce, rest but aggravated; some have low fever and night sweats, tuberculosis also need to check and exclude. 3, degenerative lesions: ① lumbar degenerative osteoarthropathy: lumbar spinal disc herniation, lumbar degenerative slippage, lumbar small joint disorders; ② lumbar spinal stenosis: central spinal stenosis, lateral saphenous stenosis. Comment: These diseases are more painful after activity 4, endocrine metabolic disorders osteoarthropathy: osteoporosis, hypothyroidism, hyperparathyroidism, etc. Point: abnormal bone metabolism often appear back pain, such as osteoporosis, and even painful vertebral compression fractures caused by osteoporosis. Bone density, thyroid function and parathyroid function need to be checked, and spinal X-rays should be taken if necessary. 5, abnormal bone development and postural diseases: ① structural abnormalities: spina bifida, migrating vertebrae, etc.; ② abnormal postural diseases: postural strain, scoliosis, youthful hunchback, lumbar lordosis and lordosis, etc. Comment: abnormal bone development or abnormal posture may cause abnormal forces, which may lead to back pain. Some even neurological diseases cause muscle ankylosis and abnormal posture. I have treated a patient with cerebral palsy who had limited spine and joint movement. 6. Spinal tumors: ① primary tumors: relatively rare, such as osteoid osteoma, bone hemangioma, etc.; ② secondary spinal tumors: tumors from other parts metastasized to the spine; ③ intraspinal tumors: nerve sheath meningioma, neurofibroma, lipoma, hemangioma, etc. Point：Tumor invasion of the spine may also have low back pain. I have screened several cases with symptoms like spinal arthritis, but the treatment effect is poor and in-depth examination reveals that it is a tumor, such as some are neurofibroma and some are metastasis of gastric cancer. (2) Involvement pain of visceral diseases 1. extraperitoneal diseases: pyelitis, pyelonephritis, kidney stones, renal tuberculosis, etc. 2.Pelvic diseases: prostatitis and tumor in men, pelvic inflammatory disease, adnexitis, uterine tumor in women, etc. 3, abdominal cavity diseases: stomach and duodenal ulcer, pancreatic cancer, liver cancer, etc. Point: Most of these involved pains will have the corresponding symptoms of the primary disease site, and the doctor can make a general judgment through questioning and physical examination, and then after examination, the problem can generally be determined. (C) Psychosomatic diseases Mental tension disorder, overwork syndrome; hysteria, depression, etc. The above factors of low back pain need to be understood and carefully analyzed before the final determination of what is causing the back pain.