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

As part of the act on Axial SpA campaign we have developed a range of presentations that will help you in your work. You can find and download our standard presentations here:

Presentation for a primary care audience – full version

This presentation is designed for an audience of primary care HCPs and contains information on NASS, what axial SpA is and the key signs and symptoms, what the act on axial SpA campaign is, what we are doing in primary care and where to find useful resources.

Presentation for a primary care audience – short version

This is a shorter more focused presentation to fit in with teaching sessions or slots and will take roughly 15 to 20 minutes. Which you can access here: Short Presentation

Video for First Contact Physiotherapists – James Holland Champion in Primary Care

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.

Presentation for gastroenterology – full version

This presentation is designed for an audience of clinicians from gastroenterology, including IBD nurses and gastroenterologists. It contains information on NASS, what axial SpA is and the key signs and symptoms, what the act on axial SpA campaign is, what we are doing in secondary care and where to find useful resources. This was developed as part of our work with gastroenterologists and rheumatologists on the links between axial SpA and IBD, it includes guidance on when to refer and how, with tools to help differentiate inflammatory from mechanical back pain.

Act on axial SpA 1st impact report

This presentation sets out the achievements from the first 18 months of the campaign and is to be used to showcase the programme and its successes to date:

AOAS Impact report

Inflammatory Back Pain – Pathways, Processes, Protocols and Guidance:

We have been curating examples from rheumatology teams we have worked with as part of both Act on axial SpA and Aspiring to Excellence. One key area to help drive down diagnostic delay is through the use of standardised and streamlined pathways.
 
Here you can find examples of inflammatory back pain pathways, from formal pathways, local processes or protocols and examples of guidance for primary care professionals (GPs and FCPs) when considering referrals.

Salford Royal Hospital - IBP pathway

SWAG - Inflammatory Back Pain referral criteria

The Salford Royal Hospital part of the Northern Care Alliance NHS Foundation Trust has developed simple guidance for primary care colleagues on screening for Inflammatory Back Pain. This protocol is used as part of local referrals.
A group of rheumatologists from across the South West of England who have a special interest in axial SpA set up the South West Axial Spondyloarthritis Group (SWAG).
As part of their work with NASS on an integrated pilot they have started to trial a common referral protocol, criteria and form across four of their hospitals based on the Torbay model.
This is being trialed across Bristol Royal Infirmary, North Bristol Trust, Royal Hospital for Rheumatological Diseases Bath and Torbay hospital.
It will be reviewed and refined with the aim of rolling out across the whole of South West.

Newcastle Hospitals - axSpA pathway

Salford Royal Hospital - axial SpA pathway

The Newcastle Hospitals NHS Foundation Trust has implemented a local pathway across primary, community and secondary care for suspected axial spondyloarthritis.
 
This pathway (below) is utilised for all suspected axSpA referrals.
The Salford Royal Hospital part of the Northern Care Alliance NHS Foundation Trust has developed an end to end axial SpA pathway, aligned to the Best MSK / GIRFT axial Spondyloarthritis pathway. It is utilised in local practice once the patient is referred to rheumatology using the IBP pathway and criteria.

Royal Berkshire - Referral Pathway

Royal Free London - IBP referral form

The Royal Berkshire NHS Foundation Trust rheumatology team have adopted the Best MSK Collaborative / GIRFT axial SpA pathway into the local axial SPA pathway.
 
They have also developed with primary care colleagues a GP electronic referral and guidance service that combines early inflammatory arthritis and axial spondyloarthritis.
 
The electronic tool sits on the local GP system and guides primary care colleagues in when and how to refer.
The Royal Free London NHS Foundation Trust axial SpA team developed a local referral form.
 
The Barnet early inflammatory back pain service referral form is to guide assessment for primary care professionals.
 
Patients are then seen in the dedicated axial SpA clinic by the rheumatology MDT. 

Clinical guidelines and protocols:

Here we have included links to a range of clinical guidelines, Best Practice protocols and tools for axial SpA diagnosis and care.
 
Click on the images and links below to access them.

GIRFT / Best MSK axial Spondyloarthritis pathway

ASAS criteria for Axial Spondyloarthritis (SpA)

BRITSpA consensus statement on acquisition and interpretation of MRI in axial SpA diagnosis

NICE Guideline - NG65

Msk? Think SpA! NICE guidance on recognition and referral of Spondyloarthritis

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.

You can also find an overview of the guidance in the following article:

McCrum C. When to suspect spondyloarthritis: A core skill in musculoskeletal clinical practice. Musculoskeletal Science & Practice. 2019 Dec;44:102079. doi: 10.1016/j.msksp.2019.102079. Epub 2019 Oct 31. PMID: 31711934.doi

SPondyloArthritis Diagnosis Evaluation (SPADE) tool

PRIMIS AxSpA GP pop up tool

Chiropractors and Osteopaths - GP referral template

PSORIASIS EPIDEMIOLOGY SCREENING TOOL (PEST) for Dermatologists

Dublin Uveitis Evaluation Tool (DUET) for Ophthalmologists

Download our posters by clicking on the images below:

Alternatively, you can email clareclark@nass.co.uk and order copies that we will print and deliver straight to you.
NASS poster with QR

Use our campaign videos in your presentations about axial SpA:

We worked with members of our community and comedians to shed light on the realities of life with axial SpA. These videos use humour to explain the issues of delayed diagnosis and ongoing, undiagnosed symptoms of axial SpA.
Use these videos (example below) as a light-hearted way to explain two major issues in axial SpA diagnosis and care, click here to view all videos.

Key act on axial SpA reports and research:

A range of clinical colleagues have handy hints and tips for you in your role. We have various reports and papers published as part of the act on Axial SpA campaign. This is underpinned by research into the delay to diagnosis. These reports and papers will help you to build a case for change, gather momentum and get buy in from key stakeholders.
 
Click on the images below to find the reports and research papers. 

Act on axial SpA: A Gold Standard Time to Diagnosis document (June 2021)

In June 2021 when we launched our Act on Axial SpA campaign we set out our proposal and road map in the Implementation Document. It details the vision for reducing the delay to diagnosis plus the evidence base for why we are proposing the changes. Read the implementation document here.

First Act on axial SpA impact report (October 2022)

In October 2022 at the All Party Parliamentary Group (APPG) on Axial Spondyloarthritis we launched the first impact report for the Act on Axial SpA programme. The report details the key results from the programme in its first 16 months. You can use this to showcase the impact the programme is making to diagnostic delay.
AOAS Impact report

The economic cost of delayed diagnosis of axial Spondyloarthritis in the UK (October 2022)

In October 2022 we published ground breaking research showing that the UK is paying an unnecessarily high price for the delays in diagnosing axial spondyloarthritis (axial SpA). Read the full research below that shows the delay costs the economy an estimated £18.7 billion a year. You can use this research to help shine a light on why the delay to diagnosis needs to end.

What do patients value and need in the diagnosis, treatment and care of axial spondyloarthritis? (November 2022)

 
In November 2022 we released the findings from our research into what patients value and need in their diagnosis, treatment and care for axial SpA. The work was part of our Aspiring to Excellence programme but has some critical evidence of the experiences that patients have while being diagnosed with axial SpA. This report will help you understand the expectations of your patients and how the journey to diagnosis is perceived. 

Review of direct referrals to rheumatology for suspected axial SpA (November 2022)

In November 2022 we released the results of research via a Freedom of Information (FOI) request and found that in many areas, specialties associated with the Extra Musculoskeletal Manifestations (EMMs) of axial SpA are able to routinely refer patients directly to rheumatology for suspected axial SpA. However, in other UK acute care settings, referrals are mostly reliant on consultant-to-consultant letters or calls. The report provides some practical advice on how referrals to rheumatology for suspected axial SpA should be made.

The use of MRI in the diagnosis of axial SpA (April 2023)

In April 2023 in collaboration with BRITSpA we are launching the results and report on the use of MRI in the diagnosis of axial SpA. The study explored if the use of MRI has changed since the 2019 BRITSpA consensus statement and shines a light on the improvements and also some new challenges. This report will give practical tools and tips on the role MRI has in the diagnostic pathway and when it is most clinically valued. Keep an eye out for our launch. 

IBD and axial SpA: how can we join the dots to ensure timely diagnosis and joint management? (June 2023)

In June 2023 NASS, in collaboration with Crohn’s & Colitis UK, and with support from the British Society for Gastroenterology (BSG), are launching the findings from our landscape review into diagnosing axial SpA in people living with inflammatory bowel disease.

As part of the NASS Act on axial SpA campaign, launched in June 2021, we developed a 22-question survey in conjunction with key clinical advisors, Crohn’s & Colitis UK and the BSG. There are two major themes emerging from this analysis to help ensure swift recognition, identification, and referral of suspected axial SpA: education and joint working with rheumatology.

Despite there being positive detection of inflammatory back pain symptoms and high confidence to refer, the survey highlights the need for regular educational sessions and resources on axial SpA that are accessible to all clinicians. Also, within secondary care, standardised screening tools and formal referral pathways could support clinicians.in identification.

Read the full report below: 

Axial SpA – How long are patients waiting for a diagnosis? (September 2023)

NASS, in collaboration with rheumatology teams from our Aspiring to Excellence programme have developed a patient survey tool to measure and monitor how long patients wait for a diagnosis of axial SpA, from symptom onset in the UK.

In September 2023 we launched the first results from the survey.

This report presents the initial results of the first four-nation UK audit of time to diagnosis in axial SpA. We don’t yet have a comprehensive picture across the UK, and the numbers of patients per department are small overall. Thus, we cannot with confidence refer to the results in the report as providing a baseline position. Nevertheless, this is already the largest current data set in the UK on diagnostic delay.

This survey and audit tool is funded by the Aspiring to Excellence programme which is led by NASS in partnership with BRITSpA and the NHS Transformation Unit and sponsored by Abbvie, Biogen, Lilly, Novartis and UCB.

The key facts from the survey based on 325 patients who submitted data and had been diagnosed since 2021 are shown below and the full report can be read by clicking on the image.

Tools for measuring the time to diagnosis:

Measurement is a key part of any improvement programme, change or campaign. There are two tools that you can use to measure the time to diagnosis in your area, understand your performance and evidence improvements. 
 
The National Early Inflammatory Arthritis (NEIAA) Audit is a clinically led audit run by the British Society for Rheumatology (BSR). It aims to improve the quality of care for people living with inflammatory arthritis, collecting information on all new patients over the age of 16 in specialist rheumatology departments in England and Wales. Embedded within the audit tool is a sepcific data set on axial SpA. You can find out more about NEIAA by clicking on the image below (left).
In October 2022 in collaboration with clinicians from our Aspiring to Excellence programme we launched a complimentary patient completed survey and audit tool to also measure specifically time to diagnosis for axial SpA. The NASS survey is simply completed by patients at the time of diagnosis, by scanning a QR code from a patient leaflet in the rheumatology department. You can read more about the NASS survey and how to sign up below (right) by clicking on the image. 

National Early Inflammatory Arthritis Audit (NEIAA)

NASS Aspiring to Excellence time to diagnosis audit

Hints and tips for recognising axial SpA and referring:

A range of clinical colleagues have handy hints and tips for you in your role. Click on the images below to find the hints, tips and videos. 

Recognising axial spondyloarthritis: Advice for GPs (Dr Danny Murphy)

Recognising axial spondyloarthritis: Advice for First Contact Practitioners (Chris Martey)

Recognising axial spondyloarthritis: Advice for physiotherapists (Claire Jeffries)

Recognising axial spondyloarthritis: Advice for chiropractors (Jonathan Field)

Recognising axial spondyloarthritis: Advice for osteopaths (Zoe Clark)

Diagnosis within rheumatology (Dr Antoni Chan)

Recognising axial SpA in dermatology (Dr Phil Laws)

Advice for gastroenterologists: axial SpA detection & treatment (Professor Tim Orchard)