Spondyloarthritis: diagnosis and management: summary of NICE guidance

Development of ASAS quality standards to improve the quality of health and care services for patients with axial spondyloarthritis

“…The UK based National Institute of Clinical Excellence (NICE) has a long trajectory of developing QS defined as a set of statements to help improve quality of health and care services and very recently published a quality assessment tool for patients with axSpA 13. The different measurement sets relate to measurable aspects of healthcare, and in contrast to guidelines or recommendations, the measurement sets do not reflect all stages and levels of disease status.…”

Taiwan Rheumatology Association consensus recommendations for the management of axial spondyloarthritis

“…Physical modalities such as hot or cold packs, hot baths, hydrotherapy, electrotherapy, diathermy, spa therapy, and mobility exercise may also be considered, as they can help to alleviate pain and may be beneficial for axSpA patients who have gastrointestinal issues and are thus unable to use NSAIDs. These recommendations are largely in line with the 2017 NICE guidance, which recommend that axSpA patients should be referred to a physiatrist or a physiotherapist to start a structured exercise program, or referred to other specialists (eg occupational therapist, orthotist, podiatrist, etc) when difficulties with daily activities emerge. A 2016 evidence‐based consensus statement regarding exercise in AS patients further recommends that exercises with an emphasis on improving or maintaining spinal mobility, such as specific proprioceptive neuromuscular facilitation techniques, are critical for advanced AS (known as “bamboo spine”) patients, and stretching, strengthening, cardiopulmonary, and functional fitness exercises are also important components of a balanced exercise program for such patients .…”

“…The formulation of these guidelines was undertaken by a committee of rheumatology and rehabilitation experts on behalf of the Taiwan Rheumatology Association (TRA). The structure of the guidelines was modeled on the recently published 2016 update of the ASAS‐European League Against Rheumatism (EULAR) management recommendations for axial spondyloarthritis, and also incorporated elements from the UK National Institute for Health and Care Excellence (NICE) 2017 guideline (NG65) on the diagnosis and management of SpA in over 16s, and the British Society for Rheumatology (BSR) and British Health Professionals in Rheumatology (BHPR) guideline for the treatment of axSpA (including AS) with biologics . The objective was to establish guidelines for the clinical management of axSpA from a local perspective that would take into account issues and concerns in clinical practice that are pertinent to Taiwan.…”

“…In recent years, several guidelines regarding the management of axial spondyloarthritis (axSpA) have been published, predominantly by societies and experts in Europe and the USA. These guidelines represent a distillation of current knowledge on axSpA, and can provide valuable guidance to clinicians; but evidence shows that the genetic features of axSpA may vary between Asian and Caucasian patients, and when clinical issues such as limited access to biologics, limited reimbursement for treatment, limited awareness, and under‐diagnosis are taken into account, it is clear that local perspectives are needed to improve the management of axSpA.…”

Laboratory tests in rheumatology: A rational approach

“…Imaging the lumbar spine is not necessary, as the sac- roiliac joints are almost invariably involved in axial spondyloarthropathy, and lesions seldom occur in the lumbar spine in isolation. 60 The diagnosis of ankylosing spondylitis previously relied on confi rmatory imaging features, but based on the new International Society classifi cation criteria, [61][62][63] which can be applied to patients with more than 3 months of back pain and age of onset of symptoms before age 45, patients can be classifi ed as having 1 of the following:…”