Toolkit for Health Care Professionals
We have been developing a toolkit of resources to help you as Health Care Professionals with improving axial SpA care and driving down diagnostic delay. Here is where you will find all the tools, presentations, posters and other materials in one place. Please use them in your work.
As a healthcare professional, what tools are available to me?
There are lots of things to help you in your everyday practice.
We have created posters, videos, presentations, educational materials and other resources you can access, print out and use to improve time to diagnosis. Access everything you need here:
Act on axial SpA presentations
Axial SpA reducing the delay to diagnosis – Presentation for health care professionals
This presentation is designed for an audience of primary care, rheumatology, or other HCPs who see patients with potential axial SpA.
It covers everything axial SpA, the key signs and symptoms, and where to find useful resources
Clinical guidelines in axial spondyloarthritis
Links to a range of clinical guidelines, NICE, ASAS, GRIFT, BRITSpA MRI guidelines
NICE guideline – NG65
MSK – Think SpA!
GIRFT / Best MSK
BRITSpA MRI guidance
The NICE guideline (NG65) covers diagnosing and managing spondyloarthritis that is suspected or confirmed in adults who are 16 years or older. It aims to raise awareness of the features of spondyloarthritis and provide clear advice on what action to take when people with signs and symptoms first present in healthcare settings. It also provides advice on the range of treatments available. The guideline is aimed at healthcare professionals, commissioners and providers, people with spondyloarthritis and their families / carers.
Dr Carol McCrum was awarded a NICE Fellowship (2017-2020) and has developed a clinical guide leaflet for clinicians to increase awareness of axial and peripheral spondyloarthritis.
The leaflet (right) is a brief guide outlining the recommendations in the NICE guideline on spondyloarthritis in over 16s on recognition, imaging recommendations and when to refer to rheumatology.
This resource is a useful tool for clinicians in digesting the NICE guidance and put it into practice, with lots of hints and tips on how to recognise and refer for spondyloarthritis.
In October 2022 working in collaboration with the NHS England Getting It Right First Time (GIRFT) and Best MSK Health Collaborative rheumatology team we were successful in embedding the Gold Standard Time To Diagnosis into the published Axial Spondyloarthritis pathway.
The Axial Spondyloarthritis pathway is one of the four core rheumatology pathways and sets out the guiderails for the end to end pathway.
The pathway is applicable in England but is relevant and can be adopted across the UK.
MRI plays a crucial role in diagnosis of axial SpA – especially in nr-AxSpA. Rheumatologists utilise imaging including MRI when making a diagnostic decision. Rheumatologists should request MRI using a spondyloarthritis protocol of the SIJ and whole spine. Rheumatologists should work closely with local MSK radiologists in the interpretation of imaging.
In 2019 BRITSpA released a consensus statement and recommendations for the acquisition and interpretation of MRI of the spine and sacroiliac joints in the diagnosis of axial SpA in the UK.
Posters for health care professionals
Click on and download our posters or email clareclark@nass.co.uk for us to print and deliver straight to you
Primary Care Poster
Uveitis & axial SpA Poster
Psoriasis & axial SpA Poster
A patient facing poster for the waiting room showing the key signs of axial SpA and driving them to the symptom checker
A ophthalmology focused poster highlighting the links between uveitis & axial SpA and when to refer
A dermatology focused poster highlighting the links between psoriasis & axial SpA and when to refer
IBD & axial SpA Poster
Gastroenterology referral process poster
A gastroenterology focused poster highlighting the links between IBD & axial SpA and when to refer
A gastroenterology focused poster highlighting the suggested referral process into rheumatology
Public Awareness Materials for Social Media
Use this imagery on your social media platforms to encourage people with chronic back pain to engage and check their symptoms
Public awareness collateral
Tools for axial SpA diagnosis
Symptom Checker, SPADE and NASS Allies template, PRIMIS
NASS symptom 8-point symptom checker
SPondyloArthritis Diagnosis Evaluation (SPADE) tool
Chiropractors and Osteopaths – GP referral template
PRIMIS AxSpA GP pop up tool
The NASS symptom checker is a simple 8-point survey completed by the patients. It is based on 3 clinically validated assessment tools for axial SpA. It helps the patient and GP understand if their symptoms could be inflammatory and axial SpA. It also provides guidance for the GP on what to do and when to refer to rheumatology.
The SPADE tool has been designed to assist medical professionals define the probability of axial spondyloarthritis in a patient with chronic back pain, below the age of 45 with no definitive changes on X-ray. This SPADE tool is intended for healthcare professionals who see patients <45 years with chronic back pain (>12 weeks).
The template is designed as a tool to assist osteopaths and chiropractors in making appropriate onward referrals to secondary care where axial SpA, is suspected. The template has been developed by NASS in partnership with the Institute of Osteopathy and the Royal College of Chiropractors.
PRIMIS, in collaboration with Prof Raj Sengupta, Consultant Rheumatologist at the Royal United Hospital Bath NHS Foundation Trust developed a pop-up tool to support the early referral of patients presenting with signs and symptoms of axial SpA, based on the ASAS IBP criteria and score.
Act on axial SpA hints and tips
Video for First Contact Physiotherapists – James Holland Champion in Primary Care
HLAB27 positive Uveitis including axial SpA – CoMIC educational video
James Holland NASS Champion in Primary Care shares tips for First Contact Physiotherapists on how to identify and diagnose axial SpA including solutions
James provides an overview of the importance of improved diagnosis in axial SpA, in addition to providing tips for recognising axial SpA for first contact physiotherapists (FCP), and gives an overview of some of the solutions being developed by the NASS Champions in Primary Care.
Click on the icon below to launch the short 7 minute video.
We were delighted to have collaborated with Dr Nima Ghadiri and the team University of Birmingham to create a CoMICs (Concise Medical Information Cines) to give ophthalmologists and rheumatologists key hints and tips in spotting the signs of axial SpA in uveitis patients.
Towards the end of the video it links to a range of our tools to help identification and referral, a key part of our campaign to end diagnostic delay in axial SpA.
Watch now below.
Real life examples
Find examples of inflammatory back pain pathways, from formal pathways, local processes or protocols and examples of guidance for primary care professionals
Salford Royal Hospital – IBP pathway
SWAG – IBP referral criteria
Newcastle Hospitals – axSpA pathway
Salford Royal Hospital – axial SpA pathway
Royal Berkshire – Referral Pathway
Royal Free London – IBP referral form
Belfast inflammatory back pain pathway
The pathway into the new clinic is embedded in the poster as are the background to the work, the results and conclusion.
