The REFLECT Study- Flares in axSpA (REFLECT)
Evidence Based, Patient-led Development of a Novel Axial Spondyloarthritis Flare Management Pathway
Axial spondyloarthritis (axSpA) is a long-term inflammatory condition that affects the spine and sacroiliac joints. People living with axSpA often experience periods when their symptoms suddenly worsen, known as disease "flares." These flares can be painful, unpredictable, and significantly affect daily life, work and psychological wellbeing. Their unpredictable nature can leave people feeling helpless and anxious about when symptoms will return.
Research has shown that severe or frequent flares are linked to worse long-term outcomes in axSpA. However, it is difficult for researchers and clinicians to clearly define what a flare is, or to predict when one will happen. There is an unmet, urgent need to improve our understanding and recognition of flares, to enable earlier and more effective intervention, and improve long-term outcomes.
This study will explore people's experiences of flares, through a real-time digital flare and symptom diary. Data will be captured digitally from people living with axSpA over 12 months, including symptoms, diet, and lifestyle, self-management strategies and impact of flare on life, work, psychological wellbeing and relationships. Participants will attend clinic at two time points only (once when in flare, once when not in flare), to collect blood (serum) samples for investigation of inflammatory markers.
Findings will enable us to define and "map" different flare experiences of people living with axSpA and identify windows of opportunity for intervention and effective management. The results will inform the development of a novel, patient-initiated digital pathway for flare identification and management, which will be discussed and refined in a series of workshops with patients and healthcare professionals. This project will take place in two UK NHS hospitals (specialist rheumatology care settings): The Royal National Hospital for Rheumatic Diseases, Bath and King's College Hospital, London. We anticipate future work to pilot test the pathway and inform potential wider NHS implementation
調査の概要
状態
状態
条件
条件
研究の種類
研究の種類
入学 (推定)
入学
連絡先と場所
研究場所
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Bath、イギリス、BA1 3NG
- Royal United Hospitals Bath NHS Foundation Trust
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London、イギリス、SE5 9RS
- King's College Hospital NHS Foundation Trust
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参加基準
適格基準
適格基準
就学可能な年齢
- 大人
- 高齢者
健康ボランティアの受け入れ
サンプリング方法
調査対象母集団
説明
Inclusion Criteria:
- Adult patients (≥18 years) with a diagnosis of axSpA (non-radiographic or radiographic axSpA).
- Access to an email address and electronic device, to participate in data collection.
- Capacity to provide informed consent.
- Sufficient communicative ability to participate in the research study (must be able to communicate in English).
- Patient has experienced at least one (self-reported) flare in the 12-months prior to enrolment.
Exclusion Criteria:
- Patients <18 years of age.
- Patients with another diagnosis of inflammatory arthritis that is not axial spondyloarthritis.
- Living with significant psychiatric morbidity, or if participation may cause distress.
- Patient has participated in Project Nightingale (RUH only, 2018 - 2022).
研究計画
研究はどのように設計されていますか?
デザインの詳細
グループ/コホートの数
コホートと介入
グループ/コホートグループ/コホート |
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axSpA patients
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この研究は何を測定していますか?
主要な結果の測定
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
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Self-reported flares
時間枠:From enrollment to end of 12 months
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To characterise flare manifestations across the heterogeneous spectrum of axSpA disease and treatments and determine how to most effectively self-manage flare to reduce their impact and duration.
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From enrollment to end of 12 months
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二次結果の測定
二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
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Flare management pathway development & refinement
時間枠:From the end of the prospective data collection, for 12 months
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To develop a novel, digitally-facilitated patient-initiated flare management pathway for people living with axSpA.
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From the end of the prospective data collection, for 12 months
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協力者と研究者
協力者
協力者
捜査官
捜査官
- 主任研究者:Raj Sengupta, Professor、Royal National Hospital for Rheumatic Diseases (RNHRD) at the Royal United Hospitals Bath NHS Foundation Trust (RUH)
出版物と役立つリンク
一般刊行物
- Skivington K, Matthews L, Simpson SA, Craig P, Baird J, Blazeby JM, Boyd KA, Craig N, French DP, McIntosh E, Petticrew M, Rycroft-Malone J, White M, Moore L. A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance. BMJ. 2021 Sep 30;374:n2061. doi: 10.1136/bmj.n2061.
- O'Cathain A, Croot L, Duncan E, Rousseau N, Sworn K, Turner KM, Yardley L, Hoddinott P. Guidance on how to develop complex interventions to improve health and healthcare. BMJ Open. 2019 Aug 15;9(8):e029954. doi: 10.1136/bmjopen-2019-029954.
- Barnett R, Ng S, Sengupta R. Understanding flare in axial spondyloarthritis: novel insights from daily self-reported flare experience. Rheumatol Adv Pract. 2021 Nov 15;5(3):rkab082. doi: 10.1093/rap/rkab082. eCollection 2021.
- Aouad K, Gossec L. Defining and managing flares in axial spondyloarthritis. Curr Opin Rheumatol. 2022 Jul 1;34(4):195-202. doi: 10.1097/BOR.0000000000000883. Epub 2022 Jun 9.
- Vasileiou K, Barnett J, Thorpe S, Young T. Characterising and justifying sample size sufficiency in interview-based studies: systematic analysis of qualitative health research over a 15-year period. BMC Med Res Methodol. 2018 Nov 21;18(1):148. doi: 10.1186/s12874-018-0594-7.
- Ondrejcakova L, Gregova M, Bubova K, Senolt L, Pavelka K. Serum biomarkers and their relationship to axial spondyloarthritis associated with inflammatory bowel diseases. Autoimmun Rev. 2024 Mar;23(3):103512. doi: 10.1016/j.autrev.2023.103512. Epub 2023 Dec 31.
- Hellman U, Lejon K, Do L, Geijer M, Baraliakos X, Witte T, Forsblad-d'Elia H. Immunological biomarkers in patients with radiographic axial spondyloarthritis, an exploratory longitudinal Swedish study. Mod Rheumatol. 2024 Dec 25;35(1):134-143. doi: 10.1093/mr/roae039.
- Liu D, Xie Y, Tu L, Wen X, Lv Q, Liu B, Yang M, Wu X, Zheng X, Luo X, Zhou L, Wu J, Liu B, Wang K, Jin O, Wang X, Qin J, Wu L, Zhao D, He D, He S, Huang W, Ye S, Zhou H, Wu J, Wang Y, Liu S, Li Z, Tan Z, Xu C, Wang Y, Zheng D, Zhan F, Lin C, Wen Y, Wu J, Wen S, Liao Z, Shen Y, Yang K, Gu J. A guideline on biomarkers in the diagnosis and evaluation in axial spondyloarthritis. Front Immunol. 2024 Oct 30;15:1394148. doi: 10.3389/fimmu.2024.1394148. eCollection 2024.
- Reilly E, Fisher C, Sengupta R. FRI0193 Prognostic markers in axial spondyloarthritis (PROMISE) - cross sectional evaluation of serum biomarkers in axspa, mechanical back pain and healthy controls. Annals of the Rheumatic Diseases. 2018;77(Suppl 2):637-.
- Carter SM, Shih P, Williams J, Degeling C, Mooney-Somers J. Conducting Qualitative Research Online: Challenges and Solutions. Patient. 2021 Nov;14(6):711-718. doi: 10.1007/s40271-021-00528-w. Epub 2021 Jun 11.
- Gandrup J, Selby DA, Dixon WG. Classifying Self-Reported Rheumatoid Arthritis Flares Using Daily Patient-Generated Data From a Smartphone App: Exploratory Analysis Applying Machine Learning Approaches. JMIR Form Res. 2024 May 14;8:e50679. doi: 10.2196/50679.
- Molto A, Gossec L, Meghnathi B, Landewe RBM, van der Heijde D, Atagunduz P, Elzorkany BK, Akkoc N, Kiltz U, Gu J, Wei JCC, Dougados M; ASAS-FLARE study group. An Assessment in SpondyloArthritis International Society (ASAS)-endorsed definition of clinically important worsening in axial spondyloarthritis based on ASDAS. Ann Rheum Dis. 2018 Jan;77(1):124-127. doi: 10.1136/annrheumdis-2017-212178. Epub 2017 Oct 16.
- van Gaalen FA, Navarro-Compan V, Baraliakos X, van den Bosch F, Gensler LS, Hmamouchi I, Landewe R, Machado PM, Marzo-Ortega H, Rodriguez VR, Poddubnyy D, Ramiro S, van der Heijde D. ASAS recommendations on reporting axial spondyloarthritis clinical trials. Ann Rheum Dis. 2025 Nov;84(11):1770-1778. doi: 10.1016/j.ard.2025.07.017. Epub 2025 Sep 6.
研究記録日
主要日程の研究
研究開始 (実際)
研究開始
一次修了 (実際)
一次修了
研究の完了 (推定)
研究の完了
試験登録日
最初に提出
最初に提出
QC基準を満たした最初の提出物
QC基準を満たした最初の提出物
最初の投稿 (実際)
最初の投稿
学習記録の更新
投稿された最後の更新 (実際)
投稿された最後の更新
QC基準を満たした最後の更新が送信されました
QC基準を満たした最後の更新が送信されました
最終確認日
最終確認日
詳しくは
本研究に関する用語
キーワード
その他の研究ID番号
その他の研究ID番号
- 364763
個々の参加者データ (IPD) の計画
個々の参加者データ (IPD) を共有する予定はありますか?
IPD プランの説明
医薬品およびデバイス情報、研究文書
米国FDA規制医薬品の研究
米国FDA規制機器製品の研究
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