Abstract Background/Aims Axial spondyloarthritis (AxSpA) is a chronic immune-mediated rheumatic condition requiring prompt diagnosis and multidisciplinary management. Delays in diagnosis and fragmented care pathways contribute to poor outcomes and increased healthcare burden. Based on Getting It Right First Time (GIRFT) guidelines and building on previous work highlighting the need for streamlined, rapid-access and specialist-led services, a physiotherapy-led AxSpA screening clinic was introduced in our Rheumatology Department to improve access, reduce diagnostic delay, and enhance patient-centred care. Methods Anonymised data were collected from patients referred to the new AxSpA clinic between its inception in November 2022 and September 2025. The clinic was led by a consultant physiotherapist embedded within a rheumatology team: with access to rheumatologist support and to imaging, including radiology weekly meetings, and onward referral pathways. Patients underwent clinical assessment and, where appropriate: bloods, including HLA-B27 testing, and imaging. Key outcomes included referral to treatment times (RTT), diagnostic conversion rates (to a diagnosis of AxSpA) and time to first biologic medication use. Results The dataset included 200 patients (mean age 37 years old; 47% female). The average RTT was 12.4 weeks, a large improvement to the general pooled wait (currently 30 weeks), but not hitting the aspirational GIRFT 8-week target. Imaging confirmed inflammatory spinal findings and/or sacroiliitis in 20% of cases (40/200). One hundred and sixty patients (80%) were discharged from Rheumatology following assessment and investigations, with the majority referred to physiotherapy for ongoing management of a non-inflammatory condition. Of the 40 patients identified as requiring further work up after their positive AxSpA protocol MR whole spine and sacroiliac scans: 32 were diagnosed with AxSpA, 2 with peripheral spondyloarthritis, 1 with psoriatic arthritis, and the other 5 were found to have a non-inflammatory musculoskeletal diagnosis after further review and radiology multi-disciplinary team discussions. The positive diagnostic rate of this AxSpA screening clinic, at 16%, is in line with international data with regards to expected conversion rate of screening clinics such as this. Time to first biologic medication (date of first rheumatology appointment to first biologic medication delivered) was at a mean average of 41.6 weeks for those in this cohort progressing to this level of medication management. Conclusion This physiotherapist-led AxSpA screening clinic has demonstrated feasibility and effectiveness in triaging patients, initiating appropriate investigations and streamlining care. The model reduces unnecessary rheumatologist appointments, improves access to imaging and facilitates early intervention for those with confirmed or suspected AxSpA. The clinic also identifies patients with non-inflammatory presentations, enabling timely discharge or redirection to appropriate services. These findings align with national GIRFT guidance and previous research advocating for advanced practice and consultant-level physiotherapist involvement in early AxSpA pathways. Disclosure W.J. Gregory: Honoraria; W.G. has received honoraria for speaker commitments from Abbvie, Janssen, Novartis, Pfizer, Sobi and UCB.
William J Gregory (Wed,) studied this question.