Is There an NP in the Rheum? The Role of Nurse Practitioners in Overcoming Underrecognition and Treatment Delays to Improve Patient Outcomes in Axial Spondyloarthritis




This CME activity for ACCME credit is provided by Integrity Continuing Education, Inc.

This CE activity for ANCC and AANP credit is jointly provided by Global Education Group and Integrity Continuing Education, Inc.


This activity is supported by an educational grant from Novartis Pharmaceuticals Corporation.


Axial Spondyloarthritis (axSpA) is a chronic, relapsing/remitting inflammatory rheumatic disease that causes low back pain. Most patients develop axSpA in the prime of their lives with 20 to 30 years old being the most common age of onset. Unfortunately, patients with axSpA wait, on average, 5 to 7 years before being diagnosed, with evidence suggesting women wait significantly longer than men. Diagnostic delay and lack of treatment can lead to spinal and sacroiliac joint fusion, abnormal formation of new bone, and disability. This problem is exacerbated by the growing shortage of rheumatologic providers.

One way to offset this imbalance is the training of nurse practitioners (NP) and physician assistants (PAs) in rheumatology. These advanced practice providers can achieve high levels of independence and clinical expertise in the management of rheumatic diseases, with responsibilities ranging from early diagnosis and clinical workups to prescribing medications. In this program, NPs and PAs will learn to differentiate inflammatory from noninflammatory pain, evaluate the response to therapy, and make treatment recommendations in axSpA, with the ultimate goals of improving patients’ access to rheumatology services and their quality of care.


Angela L. Borger, DNP, FNP-BC, DNC
Editor-in-Chief, Journal of the Dermatoloy Nurses’ Association
WellSpan Health, Department of Rheumatology
Gettysburg, Pennsylvania


Release date: August 31, 2022
Expiration date: August 31, 2023
Estimated time to complete activity: 60 minutes



This educational initiative is designed for nurse practitioners, advance practice nurses, physicians, and physician assistants who work in primary care and manage patients with axSpA.


Upon completion of this educational activity, participants should be able to:

  • Outline methods for differentiating between mechanical and inflammatory back pain using ASAS classification criteria for axSpA, based on clinical presentation, laboratory studies, and appropriate imaging
  • Explain how axSpA manifests differently in women in order to facilitate a timelier diagnosis and avoid worsening symptoms
  • Discuss how to manage the extra-articular manifestations and quality-of-life concerns that are common in patients with axSpA
  • List the guideline recommendations and clinical trial evidence to the management of axSpA

There are no fees for participating and receiving CME credit for this activity. During the period of August 31, 2022 through August 31, 2023, participants must:

  • Read the learning objectives
  • Complete the pretest
  • Study the educational activity
  • Complete the posttest and the evaluation form

A statement of credit will be issued only upon receipt of a completed activity evaluation form and a completed posttest with a score of 70% or better.




Nurse Practitioner Continuing Education

This activity has been planned and implemented in accordance with the Accreditation Standards of the American Association of Nurse Practitioners (AANP) through the joint providership of Global Education Group and Integrity Continuing Education. Global Education Group is accredited by the American Association of Nurse Practitioners as an approved provider of nurse practitioner continuing education. Provider number: 110121. This activity is approved for 1.0 contact hour (which includes 0.2 hour of pharmacology).

Nursing Continuing Education

Global Education Group is accredited with distinction as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

This educational activity for 1.0 contact hour is provided by Global Education Group. Nurses should claim only the credit commensurate with the extent of their participation in the activity.

Physician Continuing Education


Integrity Continuing Education, Inc. is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.


Integrity Continuing Education, Inc. designates this enduring material for a maximum of 1.0 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


For information about ACCME accreditation of this activity, please contact Integrity Continuing Education, Inc. at (855) 835-4004 or

For information about AANP or ANCC accreditation of this activity, please contact Global Education Group at (303) 395-1782 or


Integrity Continuing Education, Inc. and Global Education Group, requires instructors, planners, managers, and other individuals who are in a position to control the content of this activity to disclose any financial relationships with ineligible companies. All identified relevant financial relationships are thoroughly vetted by Integrity Continuing Education, Inc. for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations. All relevant financial relationships have been mitigated.

The following faculty/planners reported the financial relationships or relationships to products or devices they have with ineligible companies related to the content of this CME activity:

Angela L. Borger, DNP, FNP-BC, DNC,  has no real or apparent conflicts of interest to report.

The following project managers/planners: Olivia Benevento, Lindsay Borvansky, Ashley Cann, Donna Fausak, Andrea Funk, Liddy Knight, Rhys Williams, RN, MSN, FNP, Kristin Delisi, NP, Michelle Rizzo, ELS, and Patima Tanapat, PhD reported that they have no financial relationships or relationships to products or devices with ineligible companies related to the content of this CE activity.


This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Integrity Continuing Education, Inc. and Global Education Group do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.


When you participate in an online educational activity sponsored by Integrity Continuing Education, Inc., you will be asked for your name, degree(s), affiliation(s), street address, telephone number and…(continued)


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The information provided at this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient’s medical condition.

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