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Improving the Diagnosis and Early referral of patients with AxiaL spondyloarthiritis- BACK Pain referral pAthway from Community to Specialist care (IDEAL-BACKPACS)
Improving the Diagnosis and Early referral of patients with AxiaL spondyloarthiritis- BACK Pain referral pAthway from Community to Specialist care (IDEAL-BACKPACS)
Updated 30 September 2025
Background Axial spondyloarthritis (axSpA) is an inflammatory condition affecting 270,000 people in the UK, causing pain, stiffness and damage to the spine, pelvis and joint. Symptoms, including back pain, start in early adulthood and progress with time. Currently it takes 5-8 years to get a diagnosis. Back pain is a common symptom and the minority have axSpA, so it is difficult for GPs to tell if back pain is due to inflammation. Effective treatments are available but delayed diagnosis leads to less benefit and worse health problems. Aim To help General Practice Clinicians (GPCs) identify patients with inflammatory back pain faster to enable early diagnosis and timely access to treatment. We will design a new tool, to be integrated into GP computer systems, to help the GPCs decide if a patient needs to be referred to a specialist, and the impact of this on the patients’ wellbeing and delays in diagnosis. Method GPCs will recruit at least 720 adults aged 16-50 with longstanding back pain. These patients will attend a research clinic, where they’ll complete questionnaires, have clinical examinations, blood tests, x-rays and Magnetic Resonance Imaging (MRI) scans. We will determine which signs, symptoms and tests pick out those most likely to have axSpA, as diagnosed by a specialist. We will then use between 3 to 5 of these factors to create a new referral tool. The effectiveness of the new referral tool will be tested in a randomised controlled trial (not covered in this ethics application).
Resources
Resources
EMIS (19/11/2024)
EMIS instructions v1.0 (12/03/2025)
SystmOne (audit reports) (20/01/2025)
Updated SystmOne protocol v3 (10/07/2025)
SystmOne instructions v1.3 (01/07/2025)
SystmOne instructions for updating to protocol v3 (10/07/2025)
Disclaimer:
Please note the resources provided are designed to assist with the identification of potentially suitable patients and to appropriately code these patient if required.
These resources have been developed based on the criteria provided by the relevant study team and whilst every effort has been made to make them universally implementable they rely on read codes and the data stored in the individual practice's clinical system. These resources are intended to assist with identification but should be used in conjunction with clinical oversight and a clear understanding of the study parameters.
While we endeavour to keep the information, tools and resources provided up to date and correct, we make no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, suitability or availability with respect to the tools provided for any purpose. Any reliance you place on such information is therefore strictly at your own risk.
In no event will we be liable for any loss or damage including without limitation, indirect or consequential loss or damage, or any loss or damage whatsoever arising from loss of data or profits arising out of, or in connection with, the use of the tools provided.
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