The SPADE Tool and Building the Case for Spondyloarthritis

The SPADE tool at spadetool.co.uk lists inflammatory back pain, psoriasis, Crohn's disease, colitis, uveitis, heel pain, HLA-B27 and inflammatory markers. It works as a question prompt and gives a likelihood graph, where ticking more than one box usually puts the patient above the line recommending referral to rheumatology. Jack's tips: consider inflammatory arthritis in every back, tendon and small joint patient; flag comorbidities at the first visit and monitor them; treat differential diagnosis as an ongoing process as new symptoms or diagnoses appear; consult colleagues or rheumatology when unsure; and keep a working diagnosis open, for example when bilateral Achilles pain becomes chronic after three months. His closing case starts with plantar heel pain, then adds a history of other tendon problems in the last year, back pain, an inflammatory symptom pattern and finally psoriasis. Each step raises the likelihood, and missing one component can hide a subtle presentation.