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Diagnosis and management of spondyloarthritis in the over-16s: NICE guideline.

The National Institute for Health and Care Excellence (NICE) has developed guidelines on the diagnosis and management of spondyloarthritis (SpA) in patients aged >16 years.1

SpA encompasses a group of inflammatory conditions with some shared features, which may be predominantly axial or peripheral (Box 1) and can include extra-articular manifestations. Only 15% of cases receive a diagnosis within 3 months of presentation, and diagnosis takes 8 years on average as health providers in non-specialist settings do not always recognise SpA. The guideline aims to raise awareness of the features of SpA and provides advice on what action to take when patients with signs and symptoms first present in a healthcare setting. The terminology around SpA has changed in recent years and may be unfamiliar to non-specialists. Before the nomenclature was updated, spinal disease was called ankylosing spondylitis, whereas the new term is axial SpA. Disease affecting areas other than the spine is called peripheral SpA and the commonest form of this is psoriatic arthropathy.

Box 1. 
### Types of spondyloarthritis

| Axiala |
||
| |
| Peripheral |
| |



### Pathology

In SpA the inflammatory process occurs primarily in the enthesis (patients with rheumatoid arthritis have synovitis and tenosynovitis). Entheses are the attachment points for tendons onto bones. There are many entheses in the body, for example, Achilles at the heel, elbow where inflammation can produce tennis and golfer’s elbow, sacroiliac joints where inflammation of the entheses produces a typical appearance on X-ray, and also the plantar fascia. Dactylitis is inflammation of a whole digit (toe or finger), involving …