Working with NICE & SMC

NICE Spondyloarthritis Guideline

The Spondyloarthritis Guideline was published in February 2017 and covers both axial SpA (AS) and peripheral spondyloarthritis.

The guideline includes recommendations on:

• Recognition and referral
• Diagnosing spondyloarthritis in specialist care
• Managing spondyloarthritis
• Information and support

You can read the guideline in full on the NICE website.

NICE Quality Standard for Spondyloarthritis

In June 2018, following on from the publication of the NICE Spondyloarthritis Guideline, NICE published a Quality Standard for Spondyloarthritis.

A Quality Standard sets out the priority areas for quality improvement in health and social care. They cover areas where there is variation in care. Each standard gives:

• A set of statements to help improve quality
• Information on how to measure progress

The NICE Quality Standard for Spondyloarthritis covers four areas:

• Adults with suspected axial or peripheral spondyloarthritis are referred to a rheumatologist.
• Adults with suspected axial spondyloarthritis and an X-ray that does not show sacroiliitis have an MRI using an inflammatory back pain protocol.
• Adults with axial spondyloarthritis are referred to a specialist physiotherapist for a structured exercise programme.
• Adults with spondyloarthritis are given information about their condition, which healthcare professionals will be involved with their care, and how and when to get in touch with them.

Read the full NICE Quality Standard

NICE approved biologics

NASS works closely with NICE to ensure the best possible range of medications are available in England, Wales and Northern Ireland.

Under the current NICE anti TNF guidance:

• All the available anti TNF therapies are recommended as options for treating ankylosing spondylitis (AS)
• NICE recommend the choice of treatment should be made after discussion between the rheumatologist and the patient about the advantages and disadvantages of the treatments available.
• Adalimumab (Humira), certolizumab pegol (Cimzia) and etanercept (Enbrel) are recommended, as options for treating non-radiographic axial spondyloarthritis.
• The previous guidance specified that people needed a diagnosis of ankylosing spondylitis (AS), where changes to the sacroilliac joints and /or the spine could be seen on x-ray.
• Now the guidance includes people with non-radiographic axial spondyloarthritis which is where no changes are yet visible on x-ray.

Treatment with another anti TNF is recommended for people who cannot tolerate, or whose disease has not responded to, treatment with the first TNF-alpha inhibitor, or whose disease has stopped responding after an initial response.

Read the full guidance

IL17a inhibitors

NICE published Guidance in 2016 recommending secukinumab (Cosentyx) as an option for treating active ankylosing spondylitis in adults whose disease has responded inadequately to conventional therapy (non-steroidal anti-inflammatory drugs) or TNF-alpha inhibitors. In 2021 it was also approved for non-radiographic axial SpA.

A further IL17a inhibitor, ixekizumab (Taltz) was also approved in 2021 for both non-radiographic axial SpA and ankylosing spondylitis.

SMC approved biologics

JAK inhibitors

These drugs work by limiting the action of Janus kinase enzymes, which are involved in the inflammation that causes the symptoms of axial spondyloarthritis.

England, Wales and Northern Ireland

The National Institute for Health and Care Excellence (NICE) approved the use of the JAK inhibitor upadacitinib, also known by the brand name, Rinvoq, on 30 September 2022 for treating active ankylosing spondylitis that is not controlled well enough with conventional therapy in adults.

NICE then approved upadacitinib (Rinvoq) or treating active non-radiographic axial spondyloarthritis in adults on 01 February 2023.

NICE guidance covers England, Wales and Northern Ireland.

Scotland

Upadacitinib (Rinvoq) has been approved by the Scottish Medicines Consortium for treating active non radiographic axial spondyloarthritis and active ankylosing spondylitis in adults who have responded inadequately to conventional therapy.

Another JAK inhibitor called tofacitinib (Xeljanz) has also been accepted for use within NHS Scotland for treating active ankylosing spondylitis in adults who have responded inadequately to conventional therapy.