Inflammatory spinal disease (AxSpA) is a cause of spinal pain typically with gradual onset in those under the age of 45. It typically takes over 8 years for a correct diagnosis to be reached. Treatment in its active phase is with medication typically provided by rheumatology.

In males the majority of sufferers have positive blood tests (inflammatory markers / HLA-B27) whilst in women 75% have negative blood tests. Women suffer from later diagnosis.

A protocol has been developed based on the NICE guidelines by the National AxSpA Association, the Institute of Osteopathy and Royal College of Chiropractors with the endorsement of the Chartered Society of Physiotherapy and Royal College of General Practitioners to speed diagnosis.

Two sets of resources exist:

• The SPADE tool which has general information and an online diagnostic screen.

• The Royal College of Chiropractors templates

Here is a template letter for use if we would like to refer a patient for further investigation.

In most cases a trial of physical therapy is appropriate first. If a patient has had this (with us or elsewhere) and if 3 criteria (list below) are present send letter to GP asking for HLA-B27 test with onward referral to rheumatology if present.

If 3 or more criteria are present and HLA-B27 is negative sent to Circle for MRI to include sacroiliac joints. Reccomend onward referral to rheumatology if inflammatory signs present if not to be managed down MSK pathway.