Appraisal of Clinical Practice Guideline: NICE Guidance on Spondyloarthritis in over 16s: diagnosis and management [NG65]

摘要

June 2017. Date of next update: 2022. Patient group: People aged > 16 years with back pain or buttock pain onset before 45 years of age and lasting > 3 months, or with dactylitis or persistent or multisite tendon or joint pain or swelling, and people diagnosed with spondyloarthritis. Intended audience: Health pro- fessionals, healthcare providers, commissioners, people with sus- pected or diagnosed spondyloarthritis, and families. Expert working group: Multidisciplinary guideline development group of specialist health professionals in rheumatology (rheumatologists, radiologists, specialist physiotherapist, specialist nurse, general practitioners and occupational therapist), people with spondyloarthritis, technical an- alysts, co-opted specialists from dermatology, ophthalmology, gastroenterology and podiatry, and patient representatives. Funded by: National Institute for Health and Care Excellence (NICE). Consultation with: Final draft was informed by stakeholder consulta- tion and comments, including Chartered Society of Physiotherapy, British Society of Rheumatology and British Society of Spondyloar- thritis. Approved by: NICE. Location: The NICE website has the sum- mary of recommendations and full guideline available at: https://www. nice.org.uk/guidanceg65. There is an interactive flowchart https:// pathways.nice.org.uk/pathways/spondyloarthritis and endorsed clinical guide leaflet for clinicians available at: https://www.esht.nhs. uk/wp-content/uploads/2018/07/Msk-Think-SpA-NICE-guidance-on- recognition-and-referral-of-Spondyloarthritis.pdf. Description: The guideline covers recognition, diagnosis and management of spondy- loarthritis, which encompasses a group of inflammatory diseases associated with extra-articular inflammatory conditions including psoriasis, inflammatory bowel disease (Crohn's disease/ulcerative coli- tis) and uveitis. This guideline links with NICE Guidance on low back pain and sciatica [NG59] and outlines features that raise suspicion of spondyloarthritis, dispel common misunderstandings and give advice on when to refer to rheumatology. Recommendations on investigations, diagnosis, long-term complications and management are also provided. This includes pharmacological and non-pharmacological strategies and, in rare circumstances, surgery. Recommendations most relevant to physiotherapists include when to suspect axial or peripheral spondy- loarthritis, referral criteria, investigations, and awareness of complica- tions such as osteoporosis and non-pharmacological management.