Nurse Practitioners and Physician Assistants in Spondyloarthritis: A Narrative Review and Expert Commentary

Psoriatic arthritis and axial spondyloarthritis belong to a group of related inflammatory conditions known as spondyloarthritis (SpA), each with several musculoskeletal and extramusculoskeletal manifestations. Disease onset can be insidious, and symptoms affect patient quality of life in subtle but impactful ways, requiring careful discernment to ensure proper diagnosis and management. Heterogeneity of disease manifestations often leads to underrecognition and delayed diagnosis, resulting in suboptimal disease management and clinical outcomes. In the United States, advanced practice providers (APPs), including nurse practitioners and physician assistants, have opportunities to contribute meaningfully to the management of patients with SpA. The role of APPs in SpA management is multifaceted and includes performing patient examinations, ordering and interpreting diagnostic tests, providing differential diagnoses, determining and executing treatment plans with patient input, and evaluating treatment efficacy and safety outcomes. Further, APPs enhance care by decreasing time to clinical visits and by educating patients on disease awareness and available treatments. Having more time than rheumatologists to spend with patients is a key benefit for APPs in managing patients with SpA and ultimately results in a deeper emotional connection and understanding of the individual burdens and disease manifestations faced by these patients. The goals of this narrative review are to provide a brief overview of SpA, highlight the value of APPs in rheumatology practice in the US by reviewing recent literature, and offer expert commentary from the perspectives of both the rheumatologist and the APP on the importance of these practitioners in meeting the unique needs of patients with SpA.