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Abstract Background The aim of this study is to determine the frequency of inflammatory back pain and associated ankylosing spondylitis in rheumatoid arthritis patients. Results Sacroiliitis was found in 22% of rheumatoid arthritis patients. The frequency of rheumatoid arthritis patients who fulfilled classification criteria for spondyloarthritis or ankylosing spondylitis was 58%, in whom HLA-B27 was positive in 21 patients (35.2%) and was correlated with MRI sacroiliitis. Twenty pecent of rheumatoid arthritis patients had ankylosing spondylitis (56%) and 27% had axial spondyloarthritis. Conclusion Frequencies of inflammatory back pain and sacroiliitis in Egyptian rheumatoid arthritis patients were high.