Everyone with axial spondyloarthritis (axial SpA) deserves timely diagnosis, access to effective treatments and high-quality care, wherever they live. That’s why we work with national decision-makers, clinicians and people living with axial SpA to shape the standards of care across the UK.
Setting the standard with NICE
A major campaigning success came with the publication of the NICE Guideline for Spondyloarthritis in 2017. The guideline sets out clear recommendations to help healthcare professionals recognise, diagnose and manage both axial and peripheral spondyloarthritis.
It focuses on four key areas:
- Earlier recognition and referral
- Accurate diagnosis in specialist care
- Effective long-term management
- Information and support for patients
These recommendations are helping to reduce delays in diagnosis and improve care for thousands of people.
Driving improvement
In 2018, NICE introduced the Quality Standard for Spondyloarthritis, identifying the areas where improving care can make the biggest difference.
The Quality Standard calls for:
- Rapid referral to a rheumatologist when axial or peripheral spondyloarthritis is suspected.
- MRI scans using the correct inflammatory back pain protocol when X-rays are inconclusive.
- Referral to specialist physiotherapy and structured exercise programmes for people with axial SpA.
- Clear information so people understand their condition, their care team and how to access support.
These standards give the NHS a clear benchmark and help us hold services to account.
You can also read about our quality improvement programme Aspiring to Excellence and the achievements of the 23 rheumatology teams who took part from 2019 to 2025.
Expanding access to life-changing treatments
Access to effective medication can transform lives. We work closely with NICE to ensure people with axial SpA can benefit from the latest evidence-based treatments.
Today, NICE recommends a wide range of biologic medicines, including anti-TNF and IL-17A inhibitors, for eligible people with axial spondyloarthritis. Importantly, access has expanded beyond ankylosing spondylitis to include non-radiographic axial spondyloarthritis, meaning people no longer have to wait for permanent damage to appear on X-rays before becoming eligible for treatment. NASS has inputted into every NICE technology appraisal since these drugs were first introduced for axial SpA.
Approved treatments now include:
- Anti-TNF therapies such as adalimumab, certolizumab pegol and etanercept.
- IL-17A inhibitors including secukinumab and ixekizumab.
- Alternative biologics for people whose first treatment is ineffective or not tolerated.
- Targeted synthetic DMARDs are a more recent drug to be approved and are also known as JAK inhibitors
Working Across the UK
In Scotland, treatment approvals are made by the Scottish Medicines Consortium (SMC), which works alongside NICE guidance. We continue to campaign to ensure people across all four nations of the UK have fair and equitable access to the treatments they need.