Introducing the SPondyloArthritis Diagnosis Evaluation (SPADE) tool

Introducing the SPondyloArthritis Diagnosis Evaluation (SPADE) tool

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Dr Raj Sengupta is a Consultant Rheumatologist and Clinical Lead for Axial Spondyloarthritis at the Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust.

The SPADE tool (SPondyloArthritis Diagnosis Evaluation tool – was developed by Dr Raj Sengupta and team, based on research by Martin Rudwaleit and Ernst Feldtkeller*, to assist medical professionals in primary care in defining the likelihood that a patient has axial spondyloarthritis (axial SpA). When a patient with chronic back pain aged <45 years presents in clinic with no evidence of axial SpA changes on X-ray, simply access the tool via the website and tick the axial SpA features that apply, to determine the likelihood of axial SpA.

Upon clicking “show results”, the likelihood that the patient has axial SpA will be shown on a graph, with instructions on how to proceed.


The tool is easy to use and can be extremely helpful when considering a referral to rheumatology for a patient with potential axial SpA. However, it is important to recognise that the website cannot be used to diagnose axial SpA, as the tool does not take into account the added utility of negative findings and exclusion of differential diagnoses.

We encourage you to try utilising the tool whilst assessing your next patient with potential axial spondyloarthritis, and hope that you find it useful.


* Rudwaleit M, Feldtkeller E, Sieper J. Easy assessment of axial spondyloarthritis (early ankylosing spondylitis) at the bedside. Annals of the rheumatic diseases. 2006;65(9):1251-2.

Symptoms starting slowly

Pain in the lower back

Improves with movement

Night time waking

Early onset (under 40)