ASAS Releases Quality Standards to Improve Healthcare of Patients With Axial Spondyloarthritis

The Assessment of SpondyloArthritis International Society sought to develop a global set of quality standards to help improve healthcare quality for adult patients with axial spondyloarthritis.

The Assessment of SpondyloArthritis International Society (ASAS) developed the first set of quality standards with the objective of helping to improve the quality of healthcare provided to patients with axial spondyloarthritis (axSpA), according to a report published in the Annals of the Rheumatic Diseases.

There is currently a wide variation in the delivery and quality of healthcare for patients with axSpA. Moreover, quality standards have been published for several rheumatology conditions with the exception of axSpA. In the current report, researchers shared the following quality standards for key areas of referral, assessment, treatment, and education/self-management of axSpA and its comorbidities.


Patients with suspected axSpA should be referred to a rheumatologist for diagnostic assessment within 3 working days of presentation as this condition can often be missed in nonspecialist settings, which may lead to substantial delays in diagnosis and treatment. Since no single test has sufficient sensitivity or specificity to diagnose axSpA, experts developed the 3-working day recommendation so patients with symptoms of the disease can obtain immediate referrals. Written protocols and local arrangements to raise awareness of the signs and symptoms of axSpA will help ensure that these patients are referred to rheumatology specialists within the 3-day framework.


Patients with axSpA symptoms should be encouraged to take a diagnostic workup by a rheumatologist within 2 months after the first appointment to ensure correct diagnosis and improve long-term outcomes and quality of life. The workup should typically include the identification of SpA variables as well as laboratory and imaging studies. Patients with suspected axSpA should have increased access to a sufficient number of rheumatologists and facilities.


Discussions about treatment escalation using biologic drugs should take place between rheumatologists and patients with active axSpA disease even if patients are receiving conventional therapy. Treatment escalation may lead to better disease control, followed by remission or low disease activity. The choice of intervention should be a joint decision between both the rheumatologist and patient.

Patients with axSpA should also be informed about the benefits of nonpharmacologic interventions, including an anti-inflammatory diet and regular exercise throughout the course of disease, which may help reduce pain and stiffness, improve cardiorespiratory fitness to reduce the risk for cardiovascular disease, and improve the functioning and quality of life.

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Patients with axSpA should be provided with education and self-management information within 2 months of diagnosis. Patient education is recommended to start at diagnosis and continue for life and is essential to helping patients understand axSpA and reduce the risk for complications. Patients should be educated on how to manage symptoms and reduce pain to improve the functioning and quality of life. Education should cover information about axSpA, diagnostic utilities, treatment options and related adverse effects, and healthy lifestyle behavior. Physicians may support patients’ self-management of axSpA symptoms by providing reassuring advice about the inflammatory cause and risk for disease progression and disability, and by stressing the importance of an active lifestyle.


Patients with axSpA should be encouraged to take comprehensive annual physical exams, performed by a rheumatologist, to ensure that all aspects of the disease are under control. These examinations may also reveal axSpA-associated comorbidities, including osteoporosis, cardiovascular disease, and depression and other psychologic issues. Rheumatologists are encouraged identify comorbidities during an assessment and refer patients to other specialists as needed.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Kiltz U, Landewé RBM, van der Heijde D, et al. Development of ASAS quality standards to improve the quality of health and care services for patients with axial spondyloarthritis [published online October 11, 2019]. Ann Rheum Dis. doi:10.1136/annrheumdis-2019-216034