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Clinical performance of ASAS Health Index in patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis: real-world evidence from Multicenter Nationwide Registry

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Abstract

The Assessment of SpondyloArthritis international Society Health Index (ASAS HI) is used as a new instrument in measuring the function, disability and health of patients with spondyloarthritis (SpA). However, the real-world evidence of ASAS HI is very limited. In the present study, our objective is to evaluate the psychometric properties and performance of ASAS HI in the real-world setting as well as comparing ASAS HI with the current instruments to assess the construct validity and determine the cut-off points in patients with both ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA). A total of 991 patients with axSpA who fulfilled either the ASAS classification criteria for axial SpA (axSpA) or the Modified New York Criteria (mNY) for AS were recruited from the Biologic and targeted Synthetic antirheumatic drugs Registry (BioStaR) SpA. The construct validity of ASAS HI against the Bath Ankylosing Spondylitis Disease Activities Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score–C-Reactive Protein (ASDAS-CRP) the Bath Ankylosing Spondylitis Functional index (BASFI) was performed. Using the receiver operating characteristic (ROC) curves analysis, the cut-off points were calculated. Of all the recruited patients, 851 (85.9%) were AS and 140 (14.1%) were nr-axSpA. The difference in the mean ASAS HI scores of the patients with AS and the ones with nr-axSpA were not statistically significant (6.12 ± 4.29 and 6.42 ± 4.86, respectively). The mean ASAS HI score was significantly higher in females and small city residents. The ASAS HI had a strong construct validity against ASDAS-CRP, BASDAI and BASFI. A cut-off point of ≤ 4 was determined to discriminate good and moderate, as well as ≥ 12 to discriminate moderate and poor health status. In conclusion, ASAS HI is a reliable instrument to evaluate health and functioning for both patients with AS and nr-axSpA in clinical practice.

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References

  1. Akgul O, Ozgocmen S (2011) Classification criteria for spondyloarthropathies. World J Orthop 2(12):107–115. https://doi.org/10.5312/wjo.v2.i12.07

    Article  PubMed Central  PubMed  Google Scholar 

  2. Boonen A, Sieper J, van der Heijde D, Dougados M, Bukowski JF, Valluri S, Vlahos B, Kotak S (2015) The burden of non-radiographic axial spondyloarthritis. Semin Arthritis Rheum 44(5):556–562. https://doi.org/10.1016/j.semarthrit.2014

    Article  PubMed  Google Scholar 

  3. Deodhar A, Reveille JD, van den Bosch F, Braun J, Burgos-Vargas R, Caplan L, Clegg DO, Colbert RA, Gensler LS, van der Heijde D, van der Horst-Bruinsma IE, Inman RD, Maksymowych WP, Mease PJ, Raychaudhuri S, Reimold A, Rudwaleit M, Sieper J, Weisman MH, Landewé RB (2014) The concept of axial spondyloarthritis: joint statement of the spondyloarthritis research and treatment network and the Assessment of SpondyloArthritis international Society in response to the US Food and Drug Administration’s comments and concerns. Arthritis Rheumatol 66(10):2649–2656. https://doi.org/10.1002/art.38776

    Article  CAS  PubMed  Google Scholar 

  4. Rosenbaum JT, Pisenti L, Park Y, Howard RA (2019) Insight into the quality of life of patients with ankylosing spondylitis: real-world data from a us-based life impact survey. Rheumatol Ther 6(3):353–367. https://doi.org/10.1007/s40744-019-0160-8

    Article  PubMed Central  PubMed  Google Scholar 

  5. Kiltz U, Braun J (2020) Assessments of functioning in patients with axial spondyloarthritis. J Rheum Dis 27(1):22–29. https://doi.org/10.4078/jrd.2020.27.1.22

    Article  Google Scholar 

  6. Kiltz U, van der Heijde D, Boonen A, Cieza A, Stucki G, Khan MA, Maksymowych WP, Marzo-Ortega H, Reveille J, Stebbings S, Bostan C, Braun J (2015) Development of a health index in patients with ankylosing spondylitis ASAS HI: final result of a global initiative based on the ICF guided by ASAS. Ann Rheum Dis 74(5):830–835. https://doi.org/10.1136/annrheumdis-2013-203967

    Article  CAS  PubMed  Google Scholar 

  7. Zochling J (2011) Measures of symptoms and disease status in ankylosing spondylitis: ankylosing Spondylitis Disease Activity Score ASDAS, Ankylosing Spondylitis Quality of Life Scale ASQoL, Bath Ankylosing Spondylitis Disease Activity Index BASDAI, Bath Ankylosing Spondylitis Functional Index BASFI, Bath Ankylosing Spondylitis Global Score BAS-G, Bath Ankylosing Spondylitis Metrology Index BASMI, Dougados Functional Index DFI, and Health Assessment Questionnaire for the Spondylarthropathies HAQ-S. Arthritis Care Res 63(S11):S47–S58. https://doi.org/10.1002/acr.20575

    Article  Google Scholar 

  8. Kiltz U, van der Heijde D, Boonen A, Akkoc N, Bautista-Molano W, Burgos-Vargas R, Wei JC, Chiowchanwisawakit P, Dougados M, Duruoz MT, Elzorkany BK, Gaydukova I, Gensler LS, Gilio M, Grazio S, Gu J, Inman RD, Kim TJ, Navarro-Compan V, Marzo-Ortega H, Ozgocmen S, Pimentel Dos Santos F, Schirmer M, Stebbings S, Van den Bosch FE, van Tubergen A, Braun J (2018) Measurement properties of the ASAS Health Index: results of a global study in patients with axial and peripheral spondyloarthritis. Ann Rheum Dis 77(9):1311–1317. https://doi.org/10.1136/annrheumdis-2017-212076

    Article  PubMed  Google Scholar 

  9. Kiltz U, van der Heijde D, Boonen A, Bautista-Molano W, Burgos-Vargas R, Chiowchanwisawakit P, Duruoz T, El-Zorkany B, Essers I, Gaydukova I, Géher P, Gossec L, Grazio S, Gu J, Khan MA, Kim TJ, Maksymowych WP, Marzo-Ortega H, Navarro-Compán V, Olivieri I, Patrikos D, Pimentel-Santos FM, Schirmer M, van den Bosch F, Weber U, Zochling J, Braun J (2016) Measuring impairments of functioning and health in patients with axial spondyloarthritis by using the ASAS Health Index and the Environmental Item Set: translation and cross-cultural adaptation into 15 languages. RMD Open 2:2. https://doi.org/10.1136/rmdopen-2016-000311

    Article  Google Scholar 

  10. Di Carlo M, Lato V, Carotti M, Salaffi F (2016) Clinimetric properties of the ASAS health index in a cohort of Italian patients with axial spondyloarthritis. Health Qual Life Outcomes 14(78):016. https://doi.org/10.1186/s12955-016-0463-1

    Article  Google Scholar 

  11. Alonso S, Pardo E, Charca L, Pino M, Fernández S, Alperi M, Arboleya L, Queiro R (2020) Performance of the ASAS health index for the evaluation of spondyloarthritis in daily practice. J Rheumatol 1(200025):200025. https://doi.org/10.3899/jrheum.200025

    Article  Google Scholar 

  12. Min HK, Lee J, Ju JH, Park SH, Kwok SK (2019) Predictors of Assessment of Spondyloarthritis International Society ASAS Health Index in Axial Spondyloarthritis and Comparison of ASAS Health Index between Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis: data from the Catholic Axial Spondyloarthritis COhort CASCO. J Clin Med 8:4. https://doi.org/10.3390/jcm8040467

    Article  Google Scholar 

  13. Schmidt S, Bullinger M (2003) Current issues in cross-cultural quality of life instrument development. Arch Phys Med Rehabil 84(4 Suppl 2):50244. https://doi.org/10.1310/sci2003-181

    Article  Google Scholar 

  14. Drummond M, Barbieri M, Cook J, Glick HA, Lis J, Malik F, Reed SD, Rutten F, Sculpher M, Severens J (2009) Transferability of economic evaluations across jurisdictions: ISPOR Good Research Practices Task Force report. Value Health 12(4):409–418. https://doi.org/10.1111/j.1524-4733.2008.00489.x

    Article  PubMed  Google Scholar 

  15. Essers I, Hiligsmann M, Kiltz U, Bansback N, Braun J, van der Heijde D, Boonen A (2019) Development of one general and six country-specific algorithms to assess societal health utilities based on ASAS HI. RMD Open 5(1):2018. https://doi.org/10.1136/rmdopen-2018-000872

    Article  Google Scholar 

  16. Kiltz U, Essers I, Hiligsmann M, Braun J, Maksymowych WP, Taylor WJ, van der Heijde D, Boonen A (2016) Which aspects of health are most important for patients with spondyloarthritis? A Best Worst Scaling based on the ASAS Health Index. Rheumatology 55(10):1771–1776. https://doi.org/10.1093/rheumatology/kew238

    Article  PubMed  Google Scholar 

  17. Dougados M, Brault Y, Logeart I, van der Heijde D, Gossec L, Kvien T (2012) Defining cut-off values for disease activity states and improvement scores for patient-reported outcomes: the example of the Rheumatoid Arthritis Impact of Disease RAID. Arthritis Res Ther 14:3. https://doi.org/10.1186/ar3859

    Article  Google Scholar 

  18. Landewé RBM, Boers M, van der Heijde DMFM (2003) How to interpret radiological progression in randomized clinical trials? Rheumatology 42(1):2–5. https://doi.org/10.1093/rheumatology/keg062

    Article  PubMed  Google Scholar 

  19. Di Carlo M, Lato V, Di Matteo A, Carotti M, Salaffi F (2017) Defining functioning categories in axial Spondyloarthritis: the role of the ASAS Health Index. Rheumatol Int 37(5):713–718. https://doi.org/10.1007/s00296-016-3642-9

    Article  PubMed  Google Scholar 

  20. Rudwaleit M, van der Heijde D, Landewé R, Listing J, Akkoc N, Brandt J, Braun J, Chou CT, Collantes-Estevez E, Dougados M, Huang F, Gu J, Khan MA, Kirazli Y, Maksymowych WP, Mielants H, Sørensen IJ, Ozgocmen S, Roussou E, Valle-Oñate R, Weber U, Wei J, Sieper J (2009) The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis part II: validation and final selection. Ann Rheum Dis 68(6):777–783. https://doi.org/10.1136/ard.2009.108233

    Article  CAS  PubMed  Google Scholar 

  21. van der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 27(4):361–368. https://doi.org/10.1002/art.1780270401

    Article  PubMed  Google Scholar 

  22. Landewé R, Dougados M, Mielants H, van der Tempel H, van der Heijde D (2009) Physical function in ankylosing spondylitis is independently determined by both disease activity and radiographic damage of the spine. Ann Rheum Dis 68(6):863–867. https://doi.org/10.1136/ard.2008.091793

    Article  PubMed  Google Scholar 

  23. López-Medina C, Ramiro S, van der Heijde D, Sieper J, Dougados M, Molto A (2019) Characteristics and burden of disease in patients with radiographic and non-radiographic axial Spondyloarthritis: a comparison by systematic literature review and meta-analysis. RMD Open 5(2):2019. https://doi.org/10.1136/rmdopen-2019-001108

    Article  Google Scholar 

  24. Putrik P, Ramiro S, Moltó A, Keszei AP, Norton S, Dougados M, van der Heijde D, Landewé RBM, Boonen A (2019) Individual-level and country-level socioeconomic determinants of disease outcomes in SpA: multinational, cross-sectional study ASAS-COMOSPA. Ann Rheum Dis 78(4):486–493. https://doi.org/10.1136/annrheumdis-2018-214259

    Article  PubMed  Google Scholar 

  25. Bautista-Molano W, Landewé RBM, Kiltz U, Valle-Oñate R, van der Heijde D (2018) Validation and reliability of translation of the ASAS Health Index in a Colombian Spanish-speaking population with spondyloarthritis. Clin Rheumatol 37(11):3063–3068. https://doi.org/10.1007/s10067-018-4308-7

    Article  PubMed  Google Scholar 

  26. Ribeiro SLE, Albuquerque EN, Bortoluzzo AB, Gonçalves CR, Silva JABd, Ximenes AC, Bértolo MB, Keiserman M, Menin R, Skare TL, Carneiro S, Azevedo VF, Vieira WP, Bianchi WA, Bonfiglioli R, Campanholo C, Carvalho HMS, Costa IP, Duarte ALBP, Kohem CL, Leite NH, Lima SAL, Meirelles ES, Pereira IA, Pinheiro MM, Polito E, Resende GG, Rocha FAC, Santiago MB, Sauma MdFLC, Valim V, Sampaio-Barros PD (2016) Qualidade de vida nas espondiloartrites: análise de uma grande coorte brasileira. Revista Brasileira de Reumatologia 56:22–27. https://doi.org/10.1016/j.rbr.2015.03.003

    Article  PubMed  Google Scholar 

  27. National Research Council (US); Institute of Medicine (US) (2013) Physical and Social Environmental Factors. In: Woolf SH, Aron L (eds) Health in International Perspective: Shorter Lives, Poorer Health. The National Academic Press, Washington DC, pp 192–207

    Google Scholar 

  28. Rusman T, van Vollenhoven RF, van der Horst-Bruinsma IE (2018) Gender differences in axial spondyloarthritis: women are not so lucky. Curr Rheumatol Rep 20(6):35. https://doi.org/10.1007/s11926-018-0744-2

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  29. Chen HH, Chen YM, Lai KL, Hsieh TY, Hung WT, Lin CT, Tseng CW, Tang KT, Chou YY, Wu YD, Huang CY, Hsieh CW, Huang WN, Chen YH (2020) Gender difference in ASAS HI among patients with ankylosing spondylitis. PLoS ONE 15:e0235678. https://doi.org/10.1371/journal.pone.0235678

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  30. IbáñezVodnizza SE, van Bentum RE, Valenzuela O, van der Horst-Bruinsma IE (2020) Patients with axial spondyloarthritis report significant differences between men and women and high impact of the disease: large websurvey analysis. Joint Bone Spine 87(4):315–319. https://doi.org/10.1016/j.jbspin.2020.02.004

    Article  Google Scholar 

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Funding

This study was funded Turkish League Against Rheumatism (TLAR) (Grant number 06.23.2018-16).

Author information

Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Manisa Celal Bayar University School of Medicine, Manisa, Turkey

    Ozgur Akgul

  2. Department of Physical Medicine and Rehabilitation, Ankara City Hospital, Universiteler Mah. 1604. Cad. Cankaya, Ankara, Turkey

    Hatice Bodur & Fatma Gul Yurdakul

  3. Department of Physical Medicine and Rehabilitaton, Division of Rheumatology, Faculty of Medicine, Ankara University, Ankara, Turkey

    Sebnem Ataman

  4. Department of Physical Medicine and Rehabilitation, Karadeniz Technical University School of Medicine, Trabzon, Turkey

    Erhan Capkin

  5. Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Adnan Menderes University School of Medicine, Aydin, Turkey

    Gulcan Gurer

  6. Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Akdeniz University School of Medicine, Antalya, Turkey

    Ilhan Sezer

  7. Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Marmara University School of Medicine, Istanbul, Turkey

    Mehmet Tuncay Duruoz

  8. Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Ataturk University School of Medicine, Erzurum, Turkey

    Meltem Alkan Melikoglu

  9. Department of Rheumatology, Saglik Bilimleri University, Antalya Education and Research Hospital, Antalya, Turkey

    Hasan Fatih Cay

  10. Department of Physical Medicine and Rehabilitation, Medipol University School of Medicine, Istanbul, Turkey

    Aylin Rezvani

  11. Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, İstanbul, Turkey

    Ilker Yagci

  12. Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Gazi University School of Medicine, Ankara, Turkey

    Feride Gogus

  13. Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Sakarya University School of Medicine, Sakarya, Turkey

    Ayhan Kamanli

  14. Department of Physical Medicine and Rehabilitation, Dicle University School of Medicine, Diyarbakir, Turkey

    Remzi Cevik

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  1. Ozgur Akgul
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  2. Hatice Bodur
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  3. Sebnem Ataman
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  4. Fatma Gul Yurdakul
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  6. Gulcan Gurer
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  15. Remzi Cevik
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Contributions

All authors contributed to the study conception, design and data collection. Material preparation and analysis were performed by OA, HB, SA and FGY. The first draft of the manuscript was written by OA and all authors commented on previous versions of the manuscript. All co-authors are fully responsible for all aspects of the study and the final manuscript in line with the IJME four criteria.

Corresponding author

Correspondence to Ozgur Akgul.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

The study was approved by the Ethics Committee of Turkish Medicines and Medical Devices Agency, (66175679-514.99-E.6366) and Numune Training and Research Hospital, (E-182413). The study was conducted in accordance with the principles of the Declaration of Helsinki.

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A written informed consent was obtained from each participant.

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Electronic supplementary material

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Supplementary material 1 (DOCX 13 kb) Table S1. Comparison of ASAS HI scores between subgroups.

296_2020_4680_MOESM2_ESM.tif

Supplementary material 2 (TIFF 287 kb) Figure S1. Frequency of ASAS HI items marked as ‘I agree’ and ‘N/A’ by females and males *p < 0.05. **p < 0.001

296_2020_4680_MOESM3_ESM.tif

Supplementary material 3 (TIFF 273 kb) Figure S2. Frequency of ASAS HI items marked as ‘I agree’ and ‘N/A’ by big city residents and small city residents *p < 0.05. **p < 0.001

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Akgul, O., Bodur, H., Ataman, S. et al. Clinical performance of ASAS Health Index in patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis: real-world evidence from Multicenter Nationwide Registry. Rheumatol Int 40, 1793–1801 (2020). https://doi.org/10.1007/s00296-020-04680-8

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