A UK Best Practice Model for Diagnosis and Treatment of Axial Spondyloarthritis

Objectives: To examine the combined effectiveness of a care pathway for patients with suspected inflammatory back pain (IBP) in conjunction with an educational campaign targeting primary and secondary care and the local community. Methods: Between June 2010 and June 2013, general practitioners referred patients fulfilling the Berlin IBP criteria into our Early Inflammatory Back Pain Service (EIBPS). Investigations were undertaken in line with our service model pathway and consultant rheumatologists made a diagnosis based on the Assessment of SpondyloArthritis international Society criteria. A concurrent educational awareness campaign addressing IBP and axial spondyloarthritis (AxSpA), aimed at primary and secondary care colleagues and the local community, was undertaken in order to assist early identification of IBP. Results: Of the 222 patients referred into the EIBPS, 57 (26%) were newly diagnosed with AxSpA. A diagnosis of AxSpA was made in 48% of the patients with IBP or >1 SpA feature. The median time between onset of back pain and diagnosis was 3.1 years (mean: 5.7 years). Treatment with nonsteroidal anti-inflammatory drugs was initiated or continued as appropriate in 68/71 patients (96%; new and previously diagnosed AxSpA patients). All patients (100%) meeting the National Institute for Health and Care Excellence criteria for tumour necrosis factor inhibitor therapy were offered treatment, with 14 patients (45%) starting this treatment within 6 months of their initial EIBPS appointment. Conclusion: Our EIBPS provides a best practice model for assessment and management of patients with suspected IBP in the UK. The pathway facilitates prompt admission of appropriate patients into the service and assists early diagnosis and management of AxSpA patients.