{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T20:57:33Z","timestamp":1781297853015,"version":"3.54.1"},"reference-count":78,"publisher":"The Journal of Rheumatology","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Rheumatol"],"accepted":{"date-parts":[[2025,12,5]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3899\/jrheum.2025-0484","type":"journal-article","created":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T13:25:14Z","timestamp":1768483514000},"page":"603-611","source":"Crossref","is-referenced-by-count":0,"title":["Nurse Practitioners and Physician Assistants in Spondyloarthritis: A Narrative Review and Expert Commentary"],"prefix":"10.3899","volume":"53","author":[{"given":"Amanda","family":"Mixon","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cayla","family":"Alexander","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christy","family":"Vath","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1312-8196","authenticated-orcid":false,"given":"Eileen","family":"Lydon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6620-0457","authenticated-orcid":false,"given":"Philip","family":"Mease","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2262","published-online":{"date-parts":[[2026,1,15]]},"reference":[{"key":"2026061213100659000_53.6.603.1","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1002\/acr2.11316","article-title":"The annual diagnostic prevalence of ankylosing spondylitis and axial spondyloarthritis in the United States using Medicare and MarketScan databases","volume":"3","author":"Curtis","year":"2021","journal-title":"ACR Open Rheumatol"},{"key":"2026061213100659000_53.6.603.2","doi-asserted-by":"publisher","DOI":"10.1097\/BOR.0000000000000475"},{"key":"2026061213100659000_53.6.603.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2018.06.027"},{"key":"2026061213100659000_53.6.603.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2013.07.023"},{"key":"2026061213100659000_53.6.603.5","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2016-210242"},{"key":"2026061213100659000_53.6.603.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2021.07.021"},{"key":"2026061213100659000_53.6.603.7","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-018-4397-3"},{"key":"2026061213100659000_53.6.603.8","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.201199"},{"key":"2026061213100659000_53.6.603.9","doi-asserted-by":"publisher","DOI":"10.1136\/ard-2024-225531"},{"key":"2026061213100659000_53.6.603.10","doi-asserted-by":"publisher","DOI":"10.1136\/ard-2022-223296"},{"key":"2026061213100659000_53.6.603.11","doi-asserted-by":"publisher","DOI":"10.1002\/art.38070"},{"key":"2026061213100659000_53.6.603.12","unstructured":"American Association of Physician Associates . What is a PA? [Internet. Accessed June 24, 2024.] Available from: https:\/\/www.aapa.org\/about\/what-is-a-pa\/"},{"key":"2026061213100659000_53.6.603.13","unstructured":"American Association of Nurse Practitioners . What\u2019s a nurse practitioner (NP)? [Internet. Accessed June 24, 2024.] Available from: https:\/\/www.aanp.org\/about\/all-about-nps\/whats-a-nurse-practitioner"},{"key":"2026061213100659000_53.6.603.14","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1186\/s13075-024-03339-0","article-title":"Epidemiological trends in psoriatic arthritis: a comprehensive population-based study","volume":"26","author":"Haddad","year":"2024","journal-title":"Arthritis Res Ther"},{"key":"2026061213100659000_53.6.603.15","doi-asserted-by":"publisher","DOI":"10.1002\/acr.23518"},{"key":"2026061213100659000_53.6.603.16","doi-asserted-by":"publisher","DOI":"10.1136\/rmdopen-2018-000756"},{"key":"2026061213100659000_53.6.603.17","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.mayocp.2021.08.007","article-title":"A road map of the axial spondyloarthritis continuum","volume":"97","author":"Schwartzman","year":"2022","journal-title":"Mayo Clin Proc"},{"key":"2026061213100659000_53.6.603.18","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2009.108233"},{"key":"2026061213100659000_53.6.603.19","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1016\/j.jbspin.2016.06.005","article-title":"Diagnostic delay in axial spondyloarthritis: a cross-sectional study of 432 patients","volume":"84","author":"Masson Behar","year":"2017","journal-title":"Joint Bone Spine"},{"key":"2026061213100659000_53.6.603.20","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kez090"},{"key":"2026061213100659000_53.6.603.21","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2020.02.007"},{"key":"2026061213100659000_53.6.603.22","doi-asserted-by":"publisher","DOI":"10.1186\/s12875-020-01274-y"},{"key":"2026061213100659000_53.6.603.23","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)30830-4"},{"key":"2026061213100659000_53.6.603.24","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-204858"},{"key":"2026061213100659000_53.6.603.25","doi-asserted-by":"publisher","DOI":"10.1007\/s00296-020-04775-2"},{"key":"2026061213100659000_53.6.603.26","doi-asserted-by":"publisher","DOI":"10.1097\/BOR.0000000000000388"},{"key":"2026061213100659000_53.6.603.27","doi-asserted-by":"crossref","first-page":"1655","DOI":"10.1007\/s40744-023-00602-9","article-title":"Psoriasis and psoriatic arthritis have a major impact on quality of life and depressive symptoms: a cross-sectional study of 300 patients","volume":"10","author":"Frede","year":"2023","journal-title":"Rheumatol Ther"},{"key":"2026061213100659000_53.6.603.28","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2012-201972"},{"key":"2026061213100659000_53.6.603.29","doi-asserted-by":"publisher","DOI":"10.1002\/art.24172"},{"key":"2026061213100659000_53.6.603.30","first-page":"e34475","article-title":"Optimal use of advanced practice providers at an academic medical center: a first-year retrospective review","volume":"15","author":"Kidd","year":"2023","journal-title":"Cureus"},{"key":"2026061213100659000_53.6.603.31","unstructured":"American Association of Nurse Practitioners . Nurse practitioner curriculum. [Internet. Accessed June 12, 2024.] Available from: https:\/\/www.aanp.org\/advocacy\/advocacy-resource\/position-statements\/nurse-practitioner-curriculum"},{"key":"2026061213100659000_53.6.603.32","unstructured":"American Academy of Physician Associates . Become a PA. [Internet. Accessed June 12, 2024.] Available from: https:\/\/www.aapa.org\/career-central\/become-a-pa\/"},{"key":"2026061213100659000_53.6.603.33","unstructured":"Massachusetts College of Pharmacy and Health Sciences . Physician assistant vs nurse practitioner. [Internet. Accessed June 12, 2024.] Available from: https:\/\/www.mcphs.edu\/about\/news\/physician-assistant-vs-nurse-practitioner"},{"key":"2026061213100659000_53.6.603.34","unstructured":"American Academy of Family Physicians . Understanding nurse practitioner and physician assistant scope and education. [Internet. Accessed June 18, 2024.] Available from: https:\/\/www.aafp.org\/family-physician\/practice-and-career\/managing-your-practice\/team-based-care\/nurse-practitioner-physician-assistant-scope-education.html"},{"key":"2026061213100659000_53.6.603.35","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1002\/acr.23546","article-title":"Core curriculum to facilitate the expansion of a rheumatology practice to include nurse practitioners and physician assistants","volume":"70","author":"Smith","year":"2018","journal-title":"Arthritis Care Res"},{"key":"2026061213100659000_53.6.603.36","doi-asserted-by":"crossref","first-page":"e0146545","DOI":"10.1371\/journal.pone.0146545","article-title":"Nurse practitioners\u2019 use of communication techniques: results of a Maryland oral health literacy survey","volume":"11","author":"Koo","year":"2016","journal-title":"PLOS One"},{"key":"2026061213100659000_53.6.603.37","doi-asserted-by":"publisher","DOI":"10.1002\/msc.35"},{"key":"2026061213100659000_53.6.603.38","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1097\/00124743-200008000-00003","article-title":"Factors affecting patient satisfaction with follow-up by a nurse practitioner in an outpatient rheumatology clinic","volume":"6","author":"Wooten","year":"2000","journal-title":"J Clin Rheumatol"},{"key":"2026061213100659000_53.6.603.39","doi-asserted-by":"crossref","first-page":"e36842","DOI":"10.1097\/MD.0000000000036842","article-title":"Evaluation of nurse practitioners\u2019 roles and competencies among rheumatology nurses: results of a national survey","volume":"103","author":"Wang","year":"2024","journal-title":"Medicine"},{"key":"2026061213100659000_53.6.603.40","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1002\/2327-6924.12525","article-title":"The role of nurse practitioners in delivering rheumatology care and services: results of a U.S. survey","volume":"29","author":"Riley","year":"2017","journal-title":"J Am Assoc Nurse Pract"},{"key":"2026061213100659000_53.6.603.41","doi-asserted-by":"crossref","first-page":"1593","DOI":"10.1002\/acr.24618","article-title":"Patient acceptance of nurse practitioners and physician assistants in rheumatology care","volume":"74","author":"Frazier","year":"2022","journal-title":"Arthritis Care Res"},{"key":"2026061213100659000_53.6.603.42","doi-asserted-by":"crossref","first-page":"1664","DOI":"10.1002\/acr.22643","article-title":"Comparison of care provided in practices with nurse practitioners and physician assistants versus subspecialist physicians only: a cohort study of rheumatoid arthritis","volume":"67","author":"Solomon","year":"2015","journal-title":"Arthritis Care Res"},{"key":"2026061213100659000_53.6.603.43","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1002\/acr.23789","article-title":"Special article: 2018 American College of Rheumatology\/National Psoriasis Foundation guideline for the treatment of psoriatic arthritis","volume":"71","author":"Singh","year":"2019","journal-title":"Arthritis Care Res"},{"key":"2026061213100659000_53.6.603.44","unstructured":"Chartered Society of Physiotherapy . Advanced practice in physiotherapy. [Internet. Accessed October 24, 2025]. Available from: https:\/\/www.appn.org.uk\/cms\/wp-content\/uploads\/2015\/08\/ALP-in-physiotherapy-final.pdf"},{"key":"2026061213100659000_53.6.603.45","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-048171"},{"key":"2026061213100659000_53.6.603.46","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1093\/fampra\/cmy003","article-title":"Clinical pharmacists working within family practice: what is the evidence?","volume":"35","author":"Cardwell","year":"2018","journal-title":"Fam Pract"},{"key":"2026061213100659000_53.6.603.47","doi-asserted-by":"publisher","DOI":"10.1108\/JHOM-11-2018-0337"},{"key":"2026061213100659000_53.6.603.48","doi-asserted-by":"publisher","DOI":"10.1259\/bjr.20151066"},{"key":"2026061213100659000_53.6.603.49","doi-asserted-by":"publisher","DOI":"10.2147\/JMDH.S183397"},{"key":"2026061213100659000_53.6.603.50","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-018-2106-7"},{"key":"2026061213100659000_53.6.603.51","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1111\/j.1440-1584.2008.00962.x","article-title":"Extended scope practitioners and clinical specialists: a place in rural health?","volume":"16","author":"Ruston","year":"2008","journal-title":"Aust J Rural Health"},{"key":"2026061213100659000_53.6.603.52","unstructured":"National Health Service . Multi-professional framework for advancing clinical practice in England. [Internet. Accessed: October 24, 2025.] Available from: https:\/\/www.hee.nhs.uk\/sites\/default\/files\/documents\/multi-professionalframeworkforadvancedclinicalpracticeinengland.pdf"},{"key":"2026061213100659000_53.6.603.53","unstructured":"ACPAC . Advanced training for extended practice roles in rheumatic and musculoskeletal disease. [Internet. Accessed: October 24 2025]. Available from: https:\/\/acpacprogram.ca\/"},{"key":"2026061213100659000_53.6.603.54","unstructured":"Chartered Society of Physiotherapy . Advanced practice in physiotherapy. [Internet. Accessed: October 24, 2025]. Available from: https:\/\/www.csp.org.uk\/careers-jobs\/enhanced-advanced-consultant-practice\/advanced-practice-physiotherapy\/advanced"},{"key":"2026061213100659000_53.6.603.55","doi-asserted-by":"publisher","DOI":"10.17269\/cjph.104.4115"},{"key":"2026061213100659000_53.6.603.56","doi-asserted-by":"crossref","first-page":"2227","DOI":"10.1007\/s11136-018-1846-z","article-title":"What is the current evidence of the impact on quality of life whilst waiting for management\/treatment of orthopaedic\/musculoskeletal complaints? A systematic scoping review","volume":"27","author":"Morris","year":"2018","journal-title":"Qual Life Res"},{"key":"2026061213100659000_53.6.603.57","doi-asserted-by":"publisher","DOI":"10.1097\/01.jom.0000194161.12923.52"},{"key":"2026061213100659000_53.6.603.58","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.101315"},{"key":"2026061213100659000_53.6.603.59","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2011-201063"},{"key":"2026061213100659000_53.6.603.60","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1080\/10669817.2024.2334103","article-title":"Asymptomatic intraspinal epidermoid cyst in a 7-year-old male with juvenile idiopathic arthritis identified by an advanced physiotherapist practitioner: a case report","volume":"32","author":"Herrington","year":"2024","journal-title":"J Man Manip Ther"},{"key":"2026061213100659000_53.6.603.61","doi-asserted-by":"publisher","DOI":"10.1007\/s00296-002-0237-4"},{"key":"2026061213100659000_53.6.603.62","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.120100"},{"key":"2026061213100659000_53.6.603.63","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1002\/msc.1769","article-title":"Advanced practice physiotherapists in Scottish primary care: axial spondyloarthropathy epidemiology, time to diagnosis, and referrals to rheumatology","volume":"21","author":"Hepburn","year":"2023","journal-title":"Musculoskelet Care"},{"key":"2026061213100659000_53.6.603.64","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-14-214"},{"key":"2026061213100659000_53.6.603.65","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.180787"},{"key":"2026061213100659000_53.6.603.66","doi-asserted-by":"publisher","DOI":"10.1002\/acr.24751"},{"key":"2026061213100659000_53.6.603.67","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.ijnurstu.2016.02.009","article-title":"A multi-centre study of interactional style in nurse specialist- and physician-led rheumatology clinics in the UK","volume":"59","author":"Vinall-Collier","year":"2016","journal-title":"Int J Nurs Stud"},{"key":"2026061213100659000_53.6.603.68","doi-asserted-by":"publisher","DOI":"10.3138\/ptc.2009-35"},{"key":"2026061213100659000_53.6.603.69","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1007\/s00296-024-05603-7","article-title":"Nurses\u2019 roles, interventions, and implications for management of rheumatic diseases","volume":"44","author":"Auyezkhankyzy","year":"2024","journal-title":"Rheumatol Int"},{"key":"2026061213100659000_53.6.603.70","doi-asserted-by":"publisher","DOI":"10.1136\/rmdopen-2021-001828"},{"key":"2026061213100659000_53.6.603.71","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.anr.2019.02.004","article-title":"Effects of multidisciplinary team-based nurse-led transitional care on clinical outcomes and quality of life in patients with ankylosing spondylitis","volume":"13","author":"Liang","year":"2019","journal-title":"Asian Nurs Res"},{"key":"2026061213100659000_53.6.603.72","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1186\/s41927-020-00143-6","article-title":"Patient-initiated follow-up (PIFU) as reorganized support for increased patient involvement\u2014focus group discussions among patients\u2019 with inflammatory arthritis","volume":"4","author":"Bech","year":"2020","journal-title":"BMC Rheumatol"},{"key":"2026061213100659000_53.6.603.73","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1007\/s10067-021-05975-2","article-title":"The positive side of the coin: Sars-Cov-2 pandemic has taught us how much telemedicine is useful as standard of care procedure in real life","volume":"41","author":"El Aoufy","year":"2022","journal-title":"Clin Rheumatol"},{"key":"2026061213100659000_53.6.603.74","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.1111\/jan.14319","article-title":"A randomized controlled trial of the effects of a telehealth educational intervention on medication adherence and disease activity in rheumatoid arthritis patients","volume":"76","author":"Song","year":"2020","journal-title":"J Adv Nurs"},{"key":"2026061213100659000_53.6.603.75","doi-asserted-by":"crossref","first-page":"11","DOI":"10.2147\/OARRR.S122015","article-title":"Telemedicine delivery of patient education in remote Ontario communities: feasibility of an Advanced Clinician Practitioner in Arthritis Care (ACPAC)-led inflammatory arthritis education program","volume":"9","author":"Warmington","year":"2017","journal-title":"Open Access Rheumatol"},{"key":"2026061213100659000_53.6.603.76","unstructured":"Ullma K. ARP launches boot camp for advanced practice providers new to rheumatology. [Internet. Accessed June 4, 2024.] The Rheumatologist. Available from: https:\/\/www.the-rheumatologist.org\/article\/arp-launches-boot-camp-for-advanced-practice-providers-new-to-rheumatology\/"},{"key":"2026061213100659000_53.6.603.77","doi-asserted-by":"publisher","DOI":"10.1016\/j.berh.2007.12.006"},{"key":"2026061213100659000_53.6.603.78","doi-asserted-by":"crossref","first-page":"3512","DOI":"10.1097\/MS9.0000000000000891","article-title":"Chimeric antigen receptor T cell therapy for the treatment of systemic rheumatic diseases: a comprehensive review of recent literature","volume":"85","author":"Bhandari","year":"2023","journal-title":"Ann Med Surg"}],"container-title":["The Journal of Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.3899\/jrheum.2025-0484","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T20:10:35Z","timestamp":1781295035000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.jrheum.org\/lookup\/doi\/10.3899\/jrheum.2025-0484"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,15]]},"references-count":78,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6,1]]},"published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.3899\/jrheum.2025-0484"],"URL":"https:\/\/doi.org\/10.3899\/jrheum.2025-0484","relation":{},"ISSN":["0315-162X","1499-2752"],"issn-type":[{"value":"0315-162X","type":"print"},{"value":"1499-2752","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,15]]}}}