Top Ten Quality Standards for Spondyloarthritis
1. People with spondyloarthritis (SpA) evidenced by inflammatory back pain (IBP) for more than 3
months or arthritis suggestive of psoriatic arthritis, reactive arthritis or enteropathic arthritis,
require expert assessment by a rheumatologist.
2. People diagnosed with SpA should be offered personalised information, disease education,
vocational/occupational advice and support. They will be given opportunities for discussion
throughout their care to help them understand their condition and be involved in selfmanagement. People should be given information and contact details of an appropriate patient
support group (e.g. National Ankylosing Spondylitis Society (NASS)).
3. People with SpA should be cared for by a specialist-led multidisciplinary team, consisting of
professionals with appropriate knowledge and skills from primary and specialist care, and be
given a single point of contact responsible for managing their care (e.g. a rheumatology
consultant). People with predominant spinal symptoms should have access to a physiotherapist
for guidance, with an individualised exercise program based on the best available models (e.g.
the NASS ‘Back to action’ exercise guide).
4. Management of people with SpA should include knowledge of the impact the disease on their
ability to work, and treatment and support should be offered throughout their disease to optimise
their chances of maintaining employment.
5. People with SpA should have access to the full range of effective treatments. These should
include physiotherapy when necessary, NSAIDs including COX-2 inhibitors, and biologic drugs
including TNF inhibitors. Periodic treatment reviews should ensure that all individuals receive
treatment, which is optimally effective and tolerated.
6. People with SpA should be assessed for initiation and continuation of biologic treatments
(adalimumab, etanercept and golimumab) in line with NICE guidelines (TA 143).
7. People with SpA should be provided with written advice on early detection and management of
disease flares. They will be able to promptly access the multidisciplinary team.
8. People with SpA should receive long-term expert care and support, including annual holistic
review of the social and biological effects of their disease with an action plan to address issues
identified. This should include social roles and work, disease activity, pain, mood, joint damage,
functional ability, review of diagnoses, co-morbidities (including cardiovascular disease and
osteoporosis) and extra-articular disease (e.g. iritis, inflammatory bowel disease and psoriasis).
This will include referral to other specialities if necessary.
9. People with SpA should be offered the opportunity to participate in national and local audit and
research projects to improve the quality of their care, and that of others. This should include
collection of clinical data on responses to, and side effects of, treatment.
10. People with advanced spinal deformities should have access to spinal centres with expertise in
the surgical treatment of spondyloarthritis. Specialist orthopaedic and anaesthetic expertise
should also be accessible for care of SpA-associated hip and other peripheral skeletal disease.
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