Brief history: Female, 41 years old. She has been suffering from recurrent hip and thigh pain for 4 years. 4 years ago, she had no obvious cause for the onset of hip and thigh pain, mild soreness, mild back pain, neck stiffness and soreness, and sometimes mild pain in the knee and heel, without local swelling. X-ray report: mild degenerative changes of the cervical spine. He was treated locally with acupuncture, physiotherapy and massage according to “cervical spondylosis”, but his symptoms gradually worsened. In June 2014, he was hospitalized in the orthopedic department of a local provincial hospital, and his biochemical tests (including calcium, phosphorus, alkaline phosphatase, etc.), erythrocyte sedimentation rate and C-reactive protein were all within the normal range, and his rheumatoid factor, anti-cycloguanine polypeptide antibody and anti-keratin antibody were negative, and HLA-B27 antigen was negative. MRI of cervical, thoracic and lumbar spine: mild degenerative changes in cervical spine; mild protrusion of C4-5, C5-6 and C6-7 discs; mild bulging of C7-T1 and T1-T2 discs; no abnormalities in lumbar spine plain scan. After treatment with loxoprofen sodium for pain relief, promotion of microcirculation and calcium supplementation, there was no significant relief of symptoms. Later, he was referred to the rheumatology department, and the MRI of sacroiliac joint and MRI of hip joint: no abnormality was found in bilateral sacroiliac joints; a small amount of pelvic effusion was diagnosed as: spondyloarthritis. Treatment such as thalidomide 50-150mg 1 time/night and loxoprofen sodium 60mg 3 times/day was given, with no significant efficacy. In August 2014, he came to the PLA General Hospital and first visited the orthopedic clinic, where he was advised to come to the rheumatology clinic, considering that his disc herniation manifested very mildly and did not cause significant symptoms. CT of the sacroiliac joint was checked: no abnormality was seen. Physical examination: good spinal movement. There was no swelling and pressure pain in the joints and heels. Bilateral “4” test was negative. Addendum: In recent years, he was in a very bad mood, and the effect of repeated treatment was not good, so he often panicked and had a heavy psychological burden about the prognosis of the disease, worrying about future disability, and often cried. The local psychology department had considered the existence of a depressive state and gave him antidepressants, but he did not take them. Diagnosis: anxiety-depressive state Treatment: duloxetine 30mg 1x/day from day 1 to day 4, 60mg 1x/day thereafter; olanzapine 2.5mg 1x/bedtime. Conclusion: The symptoms were significantly reduced after a few days of taking the medication, and it was possible to climb the Great Wall. 1 month later, the symptoms were significantly reduced, with only mild thigh soreness after exertion, sleep quality turned better, and mood improved. Discussion: Low back pain has a high incidence in the population, and there are many diseases that cause low back pain, including osteoarthritis, herniated discs, lumbar strain and spinal arthritis, etc. However, it should not be overlooked that patients in a state of anxiety and depression also often have somatic manifestations of low back pain. Studies have shown that 65% of depressed patients have somatic pain, and most of them have pain in the neck, back, lumbar and lower limbs. In fact, it is common for patients with low back pain caused by anxiety and depression to be misdiagnosed as spinal arthritis (including ankylosing spondylitis), osteoarthritis, or disc herniation, etc., especially in recent years when the number of cases misdiagnosed as spinal arthritis has increased significantly. The main reason for this is the general lack of recognition of anxiety and depression disorders by non-psychological and psychiatric physicians, and another important reason is the misjudgment of some subjective indicators in the diagnostic criteria for spondyloarthritis, in particular: inflammatory low back pain. Inflammatory low back pain is an important feature of low back pain in spondyloarthritis-like disorders, i.e., low back pain that increases at night when resting and decreases after getting up and moving. Because anxiety and depression are usually combined with sleep disorders, patients feel more and more low back pain when they have insomnia in the dead of night, so it is especially easy to be misidentified as “inflammatory low back pain”, and some patients are often accompanied by pain in multiple parts of the limbs such as heel and knee, so it is easy to be misidentified as “attachment pointitis “This is why anxious and depressed patients with physical manifestations of low back pain are easily misdiagnosed as having spondyloarthritis. On the other hand, patients with real spondyloarthritis (including ankylosing spondylitis) are prone to depression because of long-term low back pain, stiffness and discomfort, and spinal deformity, etc. Günaydin et al. found that 27.4% of patients with ankylosing spondylitis had high depression scores, and Martindale et al. reported that 15% and 25% of patients with ankylosing spondylitis had depression and anxiety, respectively. . This depression can lead to aggravation of existing pain or cause pain in patients with stable disease, thus making the treatment of ankylosing spondylitis difficult. The Department of Rheumatology of the PLA General Hospital in China has conducted studies on this issue and has tried to treat patients with ankylosing spondylitis with depression by combining duloxetine with anti-rheumatic therapy, with good results.