Improving the Diagnosis and Early referral of patients with AxiaL spondyloarthritis- BACK Pain referral pAthway from Community to Specialist care (IDEAL-BACKPACS)
AxiaL spondyloarthritis
Current interventions as of 31/12/2025: Patients (aged 16-50 years with chronic back pain of ≥3 consecutive months’ duration and onset before 45 years) will be identified at their GP site (which will act as a Participant Identification Centre (PIC)) through monthly retrospective electronic health record searches. Using pre-specified SNOMED codes, GP practices will search their clinical record system to identify patients who have recently consulted with back pain. Following the search, the general practice clinician (GPC) will perform a basic screen of the potentially eligible patients identified to remove any patients who are inappropriate to invite onto the study). A full study eligibility check will be performed by the secondary care site research team. If appropriate, an SMS text message will be sent to the patient with a link to the participant information sheet (PIS) and a link to indicate whether they are happy to speak with a member of the research team from their local participating hospital. The patient will provide contact details securely via the study database and a member of the research team will contact the patient. The research team will go through the PIS with the patient, answer any questions and confirm eligibility. If the patient is eligible and happy to consent they will be provided with a link to the electronic Informed Consent form (eISF). A copy of the signed consent form will be sent to the participant from the study database. The research team will arrange a suitable time for the participant to attend a research clinic at their local secondary care site. The patient will be asked to complete an electronic online questionnaire before their hospital visit. During the hospital visit, the patient will have a clinical examination, provide relevant medical history, and have blood tests and an x-ray of their lower back and pelvis. The x-ray will be for participants aged 18 years and over. The patient will also have an MRI of their back and th
1. Aged 16-50 years with the onset of chronic back (cervical/thoracic/lumbar) pain before 45 years 2. Current back pain and at least 3 consecutive months of chronic back pain in the last 12 months 3. Ability to provide written/electronic informed consent 4. Willingness and ability to undergo study assessments (i.e., clinical assessment, X-ray, MRI, blood sample collection)
1. Existing diagnosis of axSpA 2. Existing diagnosis of inflammatory arthritis 3. GPC deems unsuitable 4. Radiation of leg pain below the knee (i.e. neuralgia/sciatica) 5. Contraindications to MRI, eg: 5.1. Pacemaker 5.2. Other ferrous metal in situ 5.3. Pregnancy (up to 12 months postpartum) 5.4. Claustrophobia 6. Suspected red flags in the history or clinical examination that may indicate further investigation or referral for possible serious underlying pathology: 6.1. Cauda Equina Syndrome 6.2. Spinal Fracture 6.3. Cancer 6.4. Bone/disc infection