RecruitingInterventional

Improving the diagnosis and referral of patients with axial spondyloarthritis into specialist care

Back pain is very common, but for some people, it is caused by an inflammatory condition called axial spondyloarthritis (axSpA). axSpA affects the spine and joints, causing chronic stiffness and pain. Right now, it takes an average of five to eight years for patients in the UK to receive a proper diagnosis, which can delay helpful treatment. This study, run by the University of Nottingham and funded by the NHS research body, aims to speed up this process. Researchers are developing a computer tool to help GPs quickly identify patients who might have axSpA and need specialist hospital care. If you are aged 16 to 50 and have had back pain for three months or more, taking part involves attending a specialist clinic for blood tests, an MRI scan, and an X-ray. You will receive a full assessment and a clear report for your GP.

At a glance

Status

Recruiting

Sponsor

University of Nottingham

Enrolment target

900

Start

03 Mar 2025

Estimated completion

28 Feb 2027

AxiaL spondyloarthritis

What is this study about?

Back pain is one of the most common reasons people visit their GP. Most back pain is not caused by anything serious. However, for around 270,000 people in the UK, back pain is caused by axial spondyloarthritis, or axSpA. This is a type of inflammatory arthritis that causes pain, stiffness, and long-term joint damage in the spine and pelvis. Symptoms usually start in early adulthood and slowly worsen over time.

Because axSpA is relatively rare compared to ordinary back strain, it can be very difficult for family doctors to spot. On average, patients wait between five and eight years from their first symptoms to receiving a diagnosis. There are effective treatments available, but they work best when started early. Waiting years for answers can lead to unnecessary suffering and lasting damage to the spine.

To solve this, researchers are creating a smart tool built into GP computer systems. This tool will help family doctors recognise the warning signs of inflammatory back pain and refer the right patients to joint specialists (rheumatologists) quickly. By comparing study test results with tool recommendations, the team hopes to prove that faster referrals can dramatically reduce delays and improve quality of life for thousands of people across the UK.

Key takeaways

The study tests a new computer tool to help GPs diagnose axial spondyloarthritis (axSpA) years faster.
Open to people aged 16 to 50 who have had back pain for at least three months.
Participants receive specialist reviews, blood tests, an MRI, and an X-ray.
Both you and your GP will get a written report detailing the likely cause of your pain.
Participation is voluntary and does not involve testing any experimental drugs.

Who may be eligible?

You may be able to join this study if you are between 16 and 50 years old and have had ongoing back pain for at least three continuous months in the past year. Your back pain must have first started before you reached the age of 45, and you must be able to attend clinic appointments for scans and blood tests.

You cannot take part if you have already been diagnosed with axSpA or another form of inflammatory arthritis. You are also not eligible if your pain shoots down your leg past the knee (sciatica), or if your doctor suspects a serious issue such as an infection, spinal fracture, cancer, or cauda equina syndrome.

Because the study involves an MRI scan, you cannot join if you have a heart pacemaker, certain metal implants, or severe claustrophobia. For safety reasons, you also cannot join if you are pregnant or have given birth within the past 12 months.

Could this study suit you?

Answer these quick questions to see if you may be eligible. This is a guide only — the research team makes the final call.

I am aged between 16 and 50 years old.
My back pain first started before I turned 45.
I have had back pain lasting for at least 3 months in a row over the last year.
I have not already been diagnosed with axSpA or another inflammatory arthritis.
I can safely have an MRI scan (no pacemaker, metal implants, pregnancy, or severe claustrophobia).
My back pain does not shoot down my leg past my knee.

Answer every question to see your result.

What does participation involve?

If you decide to take part, you will be invited to attend a specialist hospital research clinic. During this visit, a doctor will carry out a physical examination and ask you questions about your symptoms, medical history, and daily life.

You will have routine blood tests to look for markers of inflammation. You will also have an MRI scan of your spine and pelvis, and if you are 18 or older, you will have an X-ray. The study does not involve testing any new or unproven medications.

Once the tests are complete, a rheumatology specialist will review all your results. Both you and your GP will receive a detailed letter explaining whether your back pain is likely caused by axSpA or another cause, alongside helpful advice leaflets. If you are diagnosed with axSpA, you will be offered ongoing care and follow-up through NHS rheumatology services.

Potential risks and benefits

Taking part offers the benefit of a thorough hospital assessment by a joint specialist, including MRI scans that are not always easy to access quickly. You and your GP will receive clear information about your back pain, and if you have axSpA, you will be referred directly for treatment. The risks are very low. Blood tests can cause brief discomfort or slight bruising. MRI scans are noisy and require you to lie still in a tunnel, but they do not use radiation. The X-ray uses a tiny amount of radiation, adding only a 0.001% lifetime risk of health problems. Taking part is entirely voluntary, and you are free to leave the study at any time without your regular NHS medical care being affected.

Locations (8)

Some site locations are approximate. We're improving this — please verify with the trial team before travelling.

Midlands Partnership University NHS Foundation Trust
Unverified
Stafford, England
Royal United Hospitals Bath NHS Foundation Trust
Unverified
Bath, England
Liverpool University Hospitals NHS Foundation Trust
Unverified
Liverpool, England
Leeds Teaching Hospitals NHS Trust
Unverified
Leeds, England
Norfolk and Norwich University Hospitals NHS Foundation Trust
Unverified
Norwich, England
The Newcastle upon Tyne Hospitals NHS Foundation Trust
Unverified
Newcastle upon Tyne, England
Northern Care Alliance NHS Foundation Trust
Unverified
Salford, England
London North West University Healthcare NHS Trust
Unverified
Harrow, England

Common questions

Will taking part in this study cost me anything?

No, all study tests, scans, and clinic visits are provided free of charge through the NHS and study funding.

Will I have to try new, untested medicines?

No. This study focuses entirely on diagnosis and referral. It does not test any experimental medications.

What happens if the tests show I do have axSpA?

You will be given a clear diagnosis and offered an appointment with an NHS hospital rheumatology team to discuss proven treatments and a care plan.

What if the scans show my back pain is not inflammatory?

You and your GP will still receive a full report ruling out axSpA, along with advice leaflets to help manage and understand mechanical back pain.

Can I leave the study if I change my mind?

Yes, you can withdraw from the study at any point. You do not have to give a reason, and your normal healthcare will continue as usual.

How to find out more

IDEAL Trial Management Team

ideal@nottingham.ac.uk - Official trial record

Always speak to your GP or specialist before deciding to take part in a study.