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Introduction

Axial spondyloarthritis (SpA) is a chronic inflammatory disease. It affects the axial skeleton predominantly. This type of SpA includes both radiographic and non-radiographic SpA is called AxSpA or ankylosing spondylitis. These are considered as the two stages of one pathology (Adshead et al., 2020).The patient is presented with the pelvis and low back pain that is chronic with morning stiffness, (Barnett et al., 2020), like in this case study. However, other aetiologies of pain give the symptoms of intense back pains. This makes the diagnosis of SpA to be challenging to clinicians during the disease`s early stages. Seronegative Spondyloarthropathy is a rheumatic disease that involves the sacroiliac joint. In this study, the case illustrates the effective and safe care management and successful examination of axial spondyloarthritis patient in practitioner physiotherapy advanced clinic that applies NICE guidelines (Barnett et al., 2020). SpA affects mostly persons in the third decade.Due to endometriosis, it is rampant in women than in men.

 It also demonstrates the relationship between advanced practitioners and GPs in physiotherapy of muscoskeleton in NHS (Adshead et al., 2020). Based on the patient`s personal history, the description demonstrate  the appropriate threshold ofSpA(Manarad et al., 2021),which was worsened through inactivity of the body by having stiffness for about 30 minutes to one hour early in the morning. NSAIDs and body exercise improved the onset of SpA on the patient. This improvement is according to the criteria for back pain inflammation by Spondyloarthritis international society`s assessment. Axial SpA is suggested to begin in the third decade. In this case, the patient is 39 years (McCrum et al., 2019). It is characterized by irritable bowel syndrome, Reiter`s syndrome, Gluten allergies, and Psoriasis disorder (Derakhshan et al., 2020),as illustrated in this case study. This occurs within three months with the absence of the signs of dactylitis, arthritis, and enthesitis.

This can be confirmed through MRI scans and blood tests,(McCrum, 2020), which provide an effective plan for treatment and better outcomes to the patient. SpA pathology cause significant disabilities to patients in the third-decade ages like in this case study; therefore, early management and diagnosis are essential (Manara et al., 2021).If the diagnosis of SpA is delayed, the outcomes worsen, such as changes in bone pathology, spinal mobility, and function due to delayed treatment initiation to block factors of tumour necrosis which worsen to cause disability and impaired movements NICE guidelines give the required interventions to bring about care and safety of the patient based on the best outcomes of the clinical practices(Derakhshan et al., 2020). The growth of prevalence of arthritis in several countries demonstrates limited, timely access to rheumatic clinical care.

There is an increased need for orthopaedic and rheumatic care, which has led to emerging models of care that entail extended practitioner roles such as nurses, physiotherapists, and occupational therapists(Adshead et al., 2020). The comprehensive role Practitioners are skilled professionals who provide rheumatic or musculoskeletal care as first contact givers. They also make a diagnosis, prescribe medications and infiltrations, and triage candidates of surgery (Derakhshan et al., 2020). For this reason, the Advanced clinician practitioner in arthritis care has established training programs to train occupational therapists and physiotherapists to be of assistance in rheumatic care. The services given by these specialists are based on evidence-based nursing practice to ensure patient safety by providing suitable interventions for better outcomes that are person-centred (Barnett et al., 2020). In this case, the patient takes her dog on a walk to exercise the bones of which she feels pain when not exercising.