Table 3.

Quality standards (Qs) for axial spondyloarthritis, management

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)
QS7	Education and self-management	Patients with axSpA are offered education on the disease including self-management within 2 months of diagnosis.	Education is essential in enabling understanding and self-management of axSpA and reducing the risk of complications. It should start at diagnosis and continue throughout a patient's life. It is important that the patients learn how to manage their symptoms, reduce their pain and distress and improve their functioning and quality of life. Educational tasks should cover information about the disease, diagnostic utilities, treatment options including side effects, and a healthy lifestyle (physical activity and smoking cessation). Healthcare professionals can support the patient's ability to self-manage their condition by giving reassuring advice about the inflammatory cause and the risk of progressive disability of the condition, and the importance of an active lifestyle.	Evidence of local arrangements to ensure that health professionals have access to information and the knowledge needed to fully address educational needs of patients.	The number of patients diagnosed with axSpA who will have educational and self-management activities within 2 months of diagnosis.	The number of patients diagnosed with axSpA.	8.6±2.0	87.0
QS8	Rapid access	Patients with axSpA and disease flare or possibly drug-related side effects receive advice within two working days of contacting the rheumatologist.	Patients with axSpA may experience disease flares, pain intensification due to other causes or drug related side effects and may therefore have complex needs. Providing rapid access to a rheumatology service without delay maximises the impact on the person's quality of life, allowing them to continue with their usual activities and reduce the likelihood of harm from adverse events. Rapid access can be provided by all possible ways of contacting the rheumatologist (personal, by telephone or internet) (word rheumatologist implies the rheumatology team including physicians, nurses, and other health professionals).	Evidence of local arrangements to ensure that patients with axSpA receive advice within two working days of contacting the rheumatologist	The number of patients with axSpA, experiencing flares or potential side effects who contact the rheumatologist that received advice within two working day of contacting the rheumatologist	The number of patients diagnosed with axSpA.	7.8±2.4	90.0
QS9	Annual review	Patients with axSpA have a comprehensive annual review by the rheumatologist.	Annual review is important to ensure that all aspects of the disease are under control. It provides a regular opportunity to assess the patient in terms of current disease management, and any further support they may need in the future, in order to enable them to maximise their health, participation in society and life satisfaction. Focus should not only be on clinical symptoms and severity of disease but also on comorbidities like CV risk management or osteoporosis, employment, psychological factors, and life-style including physical activity. Applicability of areas covered should be individualised. A rheumatologist (which implies the rheumatology team including physicians, nurses, and other health professionals) is able to identify those aspects during an assessment and can refer to other specialty for investigations.	Evidence of local arrangements for patients with axSpA to have a comprehensive annual review that is coordinated by the rheumatology service.	The number of patients with axSpA diagnosed more than 1 year ago whose most recent comprehensive review was within 12 months of diagnosis or the previous review	The number of patients with axSpA diagnosed more than 1 year ago.	8.8±1.7	89.6

ASAS, Assessment of SpondyloArthritis International Society; axSpA, axial spondyloarthritis; CV, cardiovascular; NRS, numerical rating scale.