Who Manages Spine Arthritis
Rheumatologists should serve as the primary coordinator of care for patients with spine arthritis, leading a multidisciplinary team that includes physiotherapists, pain specialists, primary care physicians, and when necessary, orthopedic or neurosurgeons. 1
Primary Management Responsibility
The rheumatologist must coordinate all aspects of care because they possess comprehensive knowledge of the entire disease spectrum, including both musculoskeletal and extra-articular manifestations that affect approximately 40% of patients with axial spine arthritis. 1
While rheumatologists hold primary responsibility, care delivery may involve other healthcare professionals with experience in inflammatory arthritis management, particularly in regions with rheumatologist shortages. 1
In some healthcare systems, task-shifting to other trained professionals is supported to facilitate early access, but this remains under rheumatologist supervision and responsibility. 1
The Multidisciplinary Team Structure
The core team managing spine arthritis should include:
- Rheumatologist (coordinator and primary decision-maker) 1
- Physiotherapists providing active, supervised exercise programs throughout all disease stages 1, 2
- Pain specialists for patients with persistent symptoms despite conventional treatments 1
- Primary care physicians for shared care of chronic conditions and monitoring 1, 3
- Nurse specialists working within care pathways 1
- Psychologists for pain management programs when indicated 1
- Occupational therapists for functional assessment and workplace modifications 1
When to Involve Surgical Specialists
Orthopedic surgeons or neurosurgeons should be consulted when conservative management fails after at least 3-6 months, or when structural complications require surgical intervention. 1, 4
The decision for surgical intervention must be established by an interdisciplinary team including both rheumatologists and orthopedic surgeons experienced in inflammatory arthritis surgery. 5
Priority should be given to addressing the joint or spinal segment causing the greatest disability and pain. 5
Common Pitfalls in Care Coordination
Avoid "tribalism" in healthcare where different specialties fail to communicate effectively—this is particularly problematic in spinal pain management and requires organizational culture change. 1
Do not delay rheumatology referral—the median time from symptom onset to disease-modifying treatment is often 19 months, with the primary predictor being delayed first rheumatologist visit. 3
Primary care physicians tend to overdiagnose inflammatory spine arthritis and rarely initiate disease-modifying drugs themselves, making timely specialist referral critical. 3
Ensure continuous access to the rheumatology team through telephone advice or rapid assessment for emergencies or disease flares. 1
Practical Care Delivery Model
The rheumatologist should provide:
- Timely expert assessment and diagnosis with appropriate imaging and laboratory testing 1
- Treatment decisions guided by disease activity monitoring every 1-3 months until treatment targets are achieved 1
- Protocols for shared monitoring between secondary and primary care when appropriate 1
- Patient education about the disease, treatment options, and self-management strategies 1
- Coordination with other specialists for extra-articular manifestations (uveitis, inflammatory bowel disease, psoriasis) 1, 2