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Improving delays to diagnosis of Spondyloarthritis: recognition and referral of suspected axial and peripheral spondyloarthritis, and NICE recommendations on treatments. 

Spondyloarthritis is a group of inflammatory conditions that mimic common musculoskeletal problems.  Delays in diagnosis average up to 8-9 years for many people, despite significant advances in research and imaging, because it is often not recognised in musculoskeletal assessments. Screening for suspected spondyloarthritis (SpA) and when to refer onto rheumatology is an essential a core skill in clinical assessments.

Musculoskeletal clinicians are key to early diagnosis to help reduce the significant immediate and long-term impacts of these inflammatory diseases. Spondyloarthritis can be challenging to recognise and often mistaken as chronic mechanical low back pain or unrelated tendon and joint problems. The inflammatory disease links between persistent back pain, peripheral problems and extra-articular inflammatory manifestations are often missed in clinical practice.  Knowing what features should raise suspicion of spondyloarthritis and when to refer onto rheumatology is an important aspect of musculoskeletal clinical practice, along with a multidisciplinary team approach to management.

NICE Guidance has developed clinical guidance to support earlier recognition, diagnosis, treatment and other important considerations in people diagnosed with SpA. This study day aims to enable clinicians to develop their clinical knowledge and skills to screen for suspected spondyloarthritis within musculoskeletal assessments, when to refer and NICE recommendations on management. 

Summary of osteopathic practice standards (updated) covered in this course

A) Communication and patient partnership - A1, A4.A6, A6

B) Knowledge, skills and performance - B1, B2, B3

C) Safety and quality in practice - C1, C4, C6

D) Professionalism - D9, D10

Learning outcomes

Develop an awareness of the clinical presentations of axial spondyloarthritis and peripheral spondyloarthropathies. 

Gain an understanding of the importance of screening for spondyloarthritis in musculoskeletal clinical assessments. 

Develop knowledge of the clinical signs, symptoms and risk factors which increase suspicion of axial and peripheral spondyloarthritis.

Gain knowledge and skills in screening for axial and peripheral spondyloarthritis in a clinical examination.

Develop an understanding of the recommendations of NICE Guidance on Spondyloarthritis on when to refer to rheumatology and discussion on how to undertake referrals.

Develop an understanding of the role of blood tests and imaging in suspected axial and peripheral spondyloarthritis.

Gain practical skills in history taking and clinical examination for suspected spondyloarthritis and associated extra-articular manifestations, including skin and nail examination for psoriasis.

Be aware of features and develop advanced clinical reasoning skills in the differentiation of mechanical and suspected inflammatory clinical presentations.

Develop an awareness of treatment options for spondyloarthritis and supporting long-term management.

Timetable

09:00 - 09:15 Overview of Spondyloarthritis  and clinical manifestations

09:15 - 10:15 When to suspect axial and peripheral spondyloarthritis -NICE clinical guidance on referral to rheumatology

10:15 - 10:45 Imaging considerations in suspected axSpA and peripheral SpA

10:45 - 11:00 Break

11:00 - 11:15 Other considerations in people with spondyloarthritis

11:15 - 12:00 Extra-articular manifestations- considerations for clinical assessments 

12:00 - 12:30 Screening - history taking and clinical reasoning workshop

12:30 - 13:00 Referral letters and pathways- discussion and Q&A

13:00 - 14:00 Lunch

14:00 - 17:00 Evidenced based treatment and disease evaluation– NICE recommendations on treatment in axSpA, practical application and considerations for flares and supporting long term disease self-management 

17 :00-17:15 Summary, final questions and feedback questionnaires

Course suitability

This course is suitable for clinicians involved in the assessment and management of musculoskeletal conditions in daily practice, particularly those manageing persistent back pain and peripheral joint and tendon problems. It is also suitable for academic adn clinical educators involved in pre and post graduate professional education of musculoskeletal assessment and management.

About the course leaders:

Carol McCrum

Carol undertook her physiotherapy studies at  University of Sydney has been a Consultant Physiotherapist in Rheumatology and Orthopaedics in the NHS since 2005 and currently works at Canberra Hospital, Rheumatology Department, ACT. Carol completed her doctorate in acute low back pain (2011), continues clinical research and is a Visiting Research Fellow at University of Brighton. She has undertaken post-graduate training in Msk injections, non-medical  prescribing and ultrasound in rheumatology.

Carol was a committee member of the UK NICE Guidance and Quality Standards on Spondyloarthritis and was awarded a NICE Fellowship to raise awareness on recognising Spondyloarthritis in musculoskeletal assessments. Carol is involved in national and international projects, including the WHO RA Rehabilitation Guidance Development Group and All Party Parliamentary Group on Axial Spondyloarthritis. Carol is Co-Chair of the UK Rheumatology Specialist Physiotherapy Clinical Interest Group and co-author of the Rheumatology Physiotherapy Capabilities Framework (2021) that includes capabilities for the musculoskeletal clinician.

Carol is keen to continue to raise awareness about recognising rheumatology conditions and support professional development of musculoskeletal clinicians who are key to earlier recognition and referral.

Andrew MacMillan

Andrew works clinically as an Advanced Practice Osteopath in a community Rheumatology role. This involves triage and assessment of suspected rheumatological conditions in NHS patients, conducting examinations, arranging and interpreting blood testing and further imaging as appropriate to inform onward management.

His particular area of expertise is inflammatory spinal arthritis; however, he regularly works with people with other forms of inflammatory arthritis, hypermobility, fibromyalgia, widespread pain and connective tissue disorders.

Andrew is an active researcher, regularly publishing in and reviewing for several journals. He has a range of research interests including quantitative and qualitative methods, he is considered an expert in systematic and scoping review methodologies having published using these methods on a variety of topics related to education and healthcare.

In addition to his clinical and research roles Andrew regularly teaches undergraduate and postgraduate students and is an Advanced Practice center reviewer for NHS England.  He has taught at a range of osteopathic institutions including the UCO, LSO and BCNO.