Table 2.

Quality standards (QS) for axial spondyloarthritis, treatment

No	Domain	Statement	Rationale	Quality measure, category structure	Quality measure, category process, numerator	Quality measure, category process, denominator	Level of agreement, NRS 0–10	Agreement (NRS ≥7 by 75% of ASAS members)
QS4	Monitoring	Disease activity of patients with aSpA is monitored under the supervision of a rheumatologist with validated composite scores at least every 6 months.	Assessment of disease activity is of importance because of the correlation between clinical disease activity and syndesmophyte formation and between disease activity, function and health-related quality of life. Monitoring of disease activity by a rheumatologist (which implies the rheumatology team including physicians, nurses, other health professionals) is required because of multifaceted and ambiguous clinical symptoms of disease activity such as pain and disability. Assessment of disease activity using ASDAS is recommended. Repeating the assessment at regular intervals will ensure that the treatment of patients with axSpA is adapted when they need it.	Evidence of local arrangements to ensure that patients with aSpA have an assessment with validated composite scores at least every 6 months.	The number of patients diagnosed with axSpA more than 6 months ago in whom disease activity was monitored with validated composite scores at least every 6 months.	The number of patients diagnosed with axSpA more than 6 months ago.	8.0±2.2	81.7
QS5	Disease control	In patients with axSpA and active disease despite conventional therapy, treatment escalation with biological drugs is discussed.	Treatment escalation is important to achieving disease control, which ideally results in remission or a low disease activity state, and therefore lower disease impact on functioning and everyday living. Patients who have high disease activity despite conventional therapy should discuss the use of biological drugs with their rheumatologist, taking patient profile, cost and access to biologicals into account. The 2016 update of the ASAS-EULAR management recommendations for axSpA provides criteria for recommending use of biologicals in patients with axial disease and high disease activity. The choice of intervention should be a joint decision between patient and rheumatologist.	Evidence of local arrangements to ensure that patients with axSpA and active disease despite conventional therapy are offered biologicals according to the ASAS recommendations to improve the chance of remission or low disease activity in the future.	The number of patients with axSpA and active disease despite conventional therapy in whom treatment with biologicals has been discussed.	The number of patients with axSpA and active disease despite conventional therapy.	9.2±1.5	94.8
QS6	Treatment, non-pharma	Patients with axSpA are informed about the benefits of regular exercise.	Physical activity should be an integral part of standard care throughout the course of disease in patients with axSpA. It is important that patients with axSpA are given information about benefits of regular exercise to reduce pain and stiffness and improve cardiorespiratory fitness and by doing so, also reducing the risk for cardiovascular disease. Actively raising the usefulness of exercising regularly will support patients in improving functioning and maintaining quality of life.	Evidence of local arrangements to encourage patients with axSpA to exercise on a regular basis.	The number of patients diagnosed with axSpA who are informed about the benefits of regular exercise.	The number of patients diagnosed with axSpA.	9.5±0.9	98.3

ASAS, Assessment of SpondyloArthritis International Society; ASDAS, Ankylosing Spondylitis Disease Activity Score; axSpA, axial spondyloarthritis; NRS, numerical rating scale.