What criteria should I use to refer a patient with suspected spondyloarthritis to a rheumatologist?

If a person has low back pain that started before the age of 45 years and has lasted for longer than 3 months, refer the person to a rheumatologist for a spondyloarthritis assessment if 4 or more of the following additional criteria are also present:
• low back pain that started before the age of 35 years
• waking during the second half of the night because of symptoms
• buttock pain
• improvement with movement
• improvement within 48 hours of taking NSAIDs
• a first-degree relative with spondyloarthritis
• current or past arthritis
• current or past enthesitis
• current or past psoriasis.
If exactly 3 of these criteria are present, perform an HLA‑B27 test. If the test is positive, refer the person to a rheumatologist for a spondyloarthritis assessment.
Additionally, urgent referral to a rheumatologist is indicated for suspected new-onset inflammatory arthritis, unless rheumatoid arthritis, gout, or acute CPP arthritis is suspected.
Refer people with dactylitis or persistent, multi-site enthesitis, especially if associated with other signs such as back pain, uveitis, psoriasis, or gastrointestinal/genitourinary infections, for a spondyloarthritis assessment.
Refer people with signs or symptoms of undiagnosed psoriasis or acute anterior uveitis for specialist assessment, with immediate referral for acute uveitis.
Refer people with suspected axial or peripheral spondyloarthritis based on clinical suspicion, especially if they have relevant risk factors or symptoms, to a rheumatologist for further assessment.
Refer people with suspected psoriatic arthritis or other peripheral spondyloarthritides as per NICE guidelines.
Refer people with suspected reactive arthritis if indicated by clinical assessment.
Refer people with signs of acute anterior uveitis immediately for ophthalmological assessment.
In cases of persistent or atypical symptoms, consider further imaging and specialist review.