Practice Guidelines

Spondyloarthritis: NICE Releases Guidelines on Diagnosis and Treatment


Am Fam Physician. 2017 Nov 15;96(10):677-678.

Author disclosure: No relevant financial affiliations.

Key Points for Practice

• Spondyloarthritis should not be ruled out based only on negative laboratory results from HLA-B27, C-reactive protein measurement, or erythrocyte sedimentation rate testing.

• All patients diagnosed with axial spondyloarthritis should be referred to a subspecialist for a structured exercise program.

• First-line pharmacologic treatment for axial spondyloarthritis is the lowest effective dose of a nonsteroidal anti-inflammatory drug with continued evaluation and monitoring.

From the AFP Editors

Spondyloarthritis comprises inflammatory disorders that have some overlapping characteristics. Most persons with spondyloarthritis present with psoriatic arthritis or axial spondyloarthritis, including ankylosing spondylitis. Less common presentations include enteropathic spondyloarthritis, which is related to inflammatory bowel disease, and reactive arthritis, which occurs in persons after a gastrointestinal or genitourinary infection. Psoriatic arthritis has a varied presentation and can occur in small hand and foot joints, large joints such as the knee, or axial joints. Axial spondyloarthritis and ankylosing spondylitis typically occur in the spine. Lastly, there is undifferentiated spondyloarthritis, which usually occurs in fewer than five joints, but typically includes the knees.

Ankylosing spondylitis and nonradiographic axial spondyloarthritis are considered predominantly axial, whereas psoriatic arthritis, reactive arthritis, and enteropathic arthritis are considered predominantly peripheral, although features may overlap. The signs and symptoms of spondyloarthritis often go unrecognized, delaying diagnosis and treatment and increasing the risk of progression of the condition and possible disability. For this reason, the National Institute for Health and Care Excellence (NICE) released a guideline on diagnosing and treating spondyloarthritis.



Spondyloarthritis cannot be ruled out based on a single symptom or test result.

Author disclosure: No relevant financial affiliations.

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.

A collection of Practice Guidelines published in AFP is available at



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Oct 15, 2018

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