Plain English Summary
Background and study aims
Inflammatory bowel disease (IBD) describes long-term conditions that involve inflammation (swelling) of the gut. This can sometimes be associated with an arthritis called Axial Spondyloarthritis (axSpA). The arthritis causes inflammation in the spine resulting in back pain, stiffness or reduced range of movement of the spine. AxSpA is often diagnosed late because it is a relatively uncommon cause of back pain and there are many other cause of back pain which may be investigated by the doctor first. It is, however, important to make this diagnosis as early as possible in order to receive the most effective treatment.
This study aims to find out how many people with IBD also have axSpA. Further study of these participants’ characteristics will help us to develop a tool to guide investigations in patients with IBD. This aims to reduce the time to diagnosis and enable the earlier access to available treatments.
Who can participate?
Adults aged between 18 and 80 with inflammatory bowel disease
What does the study involve?
Patients with a known diagnosis of inflammatory bowel disease attending hospital appointments for this are invited to participate in the study via a postal questionnaire. If patients are deemed eligible, participants are invited to attend an assessment in the Rheumatology Department consisting of a medical interview, physical examination, blood tests and an X-ray, and a second appointment for an MRI scan of the back and pelvis.
What are the possible benefits and risks of participating?
Participants may benefit from finding an explanation for their back pain. If they are found to have inflammation in their spine or other potentially treatable causes of back pain, we recommend that their GP refer them to the main rheumatology clinic and they may be given some different treatment to help manage their symptoms.
The new diagnosis of axSpA may have implications for the participants day-to-day life (as being diagnosed with any chronic disease would) but this will allow an opportunity to start treatment earlier which is likely to outweigh any distress caused.
Where is the study run from?
Norfolk and Norwich University Hospital (UK)
When is the study starting and how long is it expected to run for?
January 2017 to July 2019
Who is funding the study?
National Ankylosing Spondylitis Society (NASS) (UK)
Who is the main contact?
Dr Chong Seng Edwin Lim
Dr Edwin Lim
Norfolk & Norwich University Hospital
Axial Spondyloarthritis in Inflammatory Bowel Disease – secondary care cross-sectional prevalence and development of an evidence-base referral tool [Norfolk - Axial SPa Ibd REferral Tool (N-ASPIRE Tool)]
This study investigates how common a diagnosis of axial spondyloarthritis (axSpA) is in patients with known inflammatory bowel disease (IBD) such as Crohn’s Disease and Ulcerative Colitis. We hope to use information from the study to develop a tool to direct referral of patients with suspected axSpA in IBD patients to a rheumatology specialist.
IBD causes inflammation of the gut leading to symptoms such as diarrhoea, abdominal pain, back passage bleeding. AxSpA is a condition that causes inflammation in the spine resulting in back pain, stiffness, reduced range of spinal movement and fatigue. Recent research has shown that there are close associations between the two conditions. Because of advances in Magnetic Resonance Imaging (MRI), it is now possible to diagnose axSpA before changes become apparent on radiography (X-ray). However, this condition is still being diagnosed late because back pain is common and axSpA is a relatively uncommon cause of back pain. Identification strategies typically focus on patients in primary care, however there is an undefined population of undiagnosed patients with axSpA-associated conditions being seen in secondary care.
We feel that it is important to understanding how common axSpA is in IBD patients as the undiagnosed cases may represent a “hidden burden” of axSpA. This will then allow further analysis to facilitate the development of a referral tool to improve identification, thereby reducing the diagnostic delay and enable access to effective treatments.
Cambridgeshire and Hertfordshire Research Ethics Committee (Research Ethics Committee), 25/05/2018, ref: 18/EE/0102
Observational cross-sectional cohort study
Primary study design
Secondary study design
Cross sectional study
Patient information sheet
Not available in web format, please use contact details to request a participant information sheet.
Axial Spondyloarthritis / Ankylosing Spondylitis
Patients with a known diagnosis of IBD attending gastroenterology appointments are invited to participate in the study via a postal questionnaire. If patients are deemed eligible, participants are invited to attend an assessment in the Rheumatology Department consisting of a medical interview, physical examination, blood tests and an X-ray, and another appointment for an MRI scan of the back and pelvis.
The N-ASPIRE referral tool is an algorithm that is developed at the analysis stage of the study formulated using data gathered from the trial.
Primary outcome measure
1. Total number of participants given a physician verified diagnosis of axial spondyloarthritis is recorded at the assessment.
2. Number of participants given a new physician verified diagnosis of axial spondyloarthritis is recorded at the assessment.
3. The sensitivity and specificity of the N-ASPIRE referral tool is assessed using positive and negative predictive values including likelihood ratios and diagnostics odd ratio.
Secondary outcome measures
Overall trial start date
Overall trial end date
Reason abandoned (if study stopped)
Participant inclusion criteria
Inclusion criteria for Phase 1 (Screening):
1. Gastroenterologist verified diagnosis of inflammatory bowel disease (Crohn’s disease or Ulcerative colitis, with either endoscopic, radiological or histological evidence of disease based on established criteria)
2. Age ≥ 18 and ≤ 80 years old
3. Patient willing and able to participate in the study
4. Including known/previous diagnosis of AS or axSpA
Inclusion criteria for Phase 2 (Clinical assessment):
1. Chronic back pain (≥ 3 months)
2. Onset of back pain before 45 years old
3. Including known/previous diagnosis of AS or axSpA (if unable to verify diagnosis retrospectively)
Target number of participants
Participant exclusion criteria
1. Any type of biologic therapy for (previous or current) treatment of IBD
2. Unable to tolerate MRI scanning (e.g. current history of claustrophobia) or contra-indication to MRI scanning
(including but not limited to e.g. pacemaker, pregnancy, metallic or conducting foreign body, etc.)
3. Age <18 or >80 years
4. Patients lacking in capacity and/or unable to give informed consent
5. Patients unable to understand English to sufficient degree to be able to complete a questionnaire
8. Patient unwilling to take part in the study
Recruitment start date
Recruitment end date
Countries of recruitment
Trial participating centre
NORFOLK AND NORWICH UNIVERSITY HOSPITALS NHS FOUNDATION TRUST
Norfolk & Norwich University Hospital NHS Foundation Trust (NNUH) - Lead Sponsor
Level 3 East Block
Norfolk & Norwich University Hospitals NHS Foundation Trust
University of East Anglia (UEA) – Co-sponsor
Research and Innovation Services (RIN) Registry
University of East Anglia
Norwich Research Park
National Ankylosing Spondylitis Society (NASS)
Funding Body Type
Funding Body Subtype
Results and Publications
Publication and dissemination plan
Planned publication in a high-impact peer reviewed journal estimated 2020.
IPD sharing statement:
The datasets generated during and/or analysed during the current study are/will be available upon request from Dr Edwin Lim. email@example.com.
Intention to publish date
Participant level data
Available on request
Basic results (scientific)