New guidelines on diagnosis and management of spondyloarthritis

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The guideline includes information on recognising spondyloarthritis in individuals aged 16 or older.

New guidelines from the UK’s National Institute for Health and Care Excellence (NICE) aim 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”.

Latest estimates suggest the global prevalence of spondyloarthritis ranges from 0.2 per cent to 1.61 per cent.

The guidelines recommend that patients with low back pain that started before the age of 35 years and has lasted for longer than 3 months, are referred to a rheumatologist for a spondyloarthritis assessment if they also have four or more of the following additional criteria:

  • waking during the second half of the night because of symptoms;
  • buttock pain;
  • improvement with movement;
  • improvement within 48 hours of non-steroidal anti-inflammatory drugs;
  • a first-degree relative with spondyloarthritis;
  • current or past arthritis;
  • current or past enthesitis;
  • current or past psoriasis.

NICE says it should be recognised that spondyloarthritis can have diverse symptoms and can be difficult to identify. It advised doctors to “be aware that axial and peripheral spondyloarthritis may be missed, even if the onset is associated with established comorbidities”.


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