Table 1

Quality standards (QS) for axial spondyloarthritis, clinical symptoms and diagnosis

NoDomainStatementRationaleQuality measure, category structureQuality measure, category process, numeratorQuality measure, category process, denominatorLevel of agreement, NRS 0–10Agreement (NRS ≥7 by 75% of ASAS members)
QS1ReferralPatients with suspicion of axSpA are referred to a rheumatologist for diagnostic assessment within three working daysWhen axSpA is suspected, ASAS recommendations for the early referral of patients with a clinical suspicion of axSpA provide criteria for deciding whether the patient should be referred to rheumatology for special diagnostic assessment. AxSpA is often missed in non-specialist settings, resulting in substantial delays in diagnosis and treatment. No single test has been shown to have sufficient sensitivity or specificity to diagnose axSpA. Timeframe of three working days is expert-driven intending to trigger immediate referrals.Evidence of local arrangements (including local arrangements to raise awareness of signs and symptoms of axSpA) and written protocols to ensure that patients with suspicion for axSpA are referred to rheumatology within three working days.The number of patients with a suspicion of axSpA that is referred to rheumatology within three working days.The number of patients with a suspicion of axSpA.6.0±3.1
second vote: 88.5%.
47.8
QS2Time to specialistPatients with suspicion of axSpA are assessed by a rheumatologist within 3 weeks after referralRapid referral of patients with suspicion of axSpA is important to avoid delay in diagnosis and increase the likelihood of early treatment initiation. A rheumatologist (which implies the rheumatology team including physicians, nurses, and other health professionals) is able to identify axial and peripheral manifestations as well as extra-articular manifestations and comorbidities. Given the potentially detrimental effects of delayed diagnosis, patients with these symptoms and signs are in need of a first appointment within 3 weeks. Timeframe is expert-driven intending to trigger timely appointments. Timeframe of 3 weeks refers to a first appointment. Additional examinations required for decision-making process can follow after the first appointment.Evidence of local arrangements including sufficient number of rheumatologists to ensure that patients with suspicion of axSpA can be seen by a rheumatology specialist within 3 weeks after referral.The number of patients with a suspicion of axSpA that is assessed by a rheumatologist within 3 weeks after referral.The number of patients with suspicion of axSpA referred to a rheumatologist.7.2±2.5
second vote: 86.7%.
69.6
QS3AssessmentPatients with suspicion of axSpA have their diagnostic work-up completed within 2 months.Timely diagnostic work-up by a rheumatologist is needed to ensure correct diagnosis and to achieve better long-term outcomes and improve their quality of life. Diagnostic work-up includes identification of SpA variables, laboratory and imaging results. Diagnostic work-up should be completed within 2 months after first appointment.Evidence of local arrangements including sufficient number of rheumatologists and facilities and access to facilities in the given timeframe to ensure that patients with suspicion of axSpA have a diagnostic work-up within 2 months after first appointment by a rheumatologist.The number of patients with a suspicion of axSpA, in whom a diagnostic work up was completed within 2 months after first appointment.The number of patients with suspicion of axSpA seen for the first time by the rheumatologist more than 2 months ago.8.5±2.089.6
  • ASAS, Assessment of SpondyloArthritis International Society; axSpA, axial spondyloarthritis; NRS, numerical rating scale.