Abstract
Recently, the Ankylosing Spondylitis Disease Activity Score (ASDAS), a new index, has been shown to be validated and highly discriminatory in assessing ankylosing spondylitis (AS) disease activity. This study is to evaluate the performance of ASDAS in a local Chinese cohort of AS in a cross-sectional setting and to compare it with the existing instrument, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Consecutive patients with AS were recruited from a local rheumatology clinic. Data, including BASDAI, Bath Ankylosing Spondylitis Functional Index (BASFI), Visual Analogue Scale (VAS) for spinal pain, and patient and physician global assessments were gathered during clinic visit. Inflammatory markers, including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and high-sensitivity (hs)-CRP were collected. ASDAS was calculated accordingly. The discriminatory capacity of BASDAI and ASDAS was compared by: (1) standardized mean difference statistics, (2) R 2 in linear regressions, and (3) area under receiver operating characteristic curve (AUC) in logistic regression models. Both ASDAS and BASDAI showed satisfactory predictive value on disease activity with reference to patient and physician global assessment. R 2 in linear regression models ranged from 0.6–0.7. Both indices also demonstrated good discriminatory capacity as evidenced by a relatively high AUC (> 0.8) under the logistic regression models using either patient or physician global assessment score ≥4 and <4 as cut off of high and low disease activity status, respectively. Although we could not demonstrate significant differences in the performance between them, subgroup analysis suggested better discriminatory ability of ASDAS in the high inflammatory marker subgroup. ASDAS and BASDAI showed similarly good performance in a cross-sectional setting in a local Chinese AS cohort. ASDAS performed better in subgroup with raised inflammatory markers.
Similar content being viewed by others
References
Haywood KL, Garratt AM, Dawes PT (2005) Patient-assessed health in ankylosing spondylitis: a structured review. Rheumatology (Oxford) 44(5):577–586
Calin A, Nakache JP, Gueguen A, Zeidler H, Mielants H, Dougados M (1999) Defining disease activity in ankylosing spondylitis: is a combination of variables (Bath Ankylosing Spondylitis Disease Activity Index) an appropriate instrument? Rheumatology (Oxford) 38(9):878–882
Lukas C, Landewe R, Sieper J, Dougados M, Davis J, Braun J et al (2009) Development of an ASAS-endorsed disease activity score (ASDAS) in patients with ankylosing spondylitis. Ann Rheum Dis 68(1):18–24
van der Heijde D, Lie E, Kvien TK, Sieper J, Van den Bosch F, Listing J et al (2009) ASDAS, a highly discriminatory ASAS-endorsed disease activity score in patients with ankylosing spondylitis. Ann Rheum Dis 68(12):1811–1818
Wei JC, Wong RH, Huang JH, Yu CT, Chou CT, Jan MS et al (2007) Evaluation of internal consistency and re-test reliability of Bath ankylosing spondylitis indices in a large cohort of adult and juvenile spondylitis patients in Taiwan. Clin Rheumatol 26(10):1685–1691
Nas K, Yildirim K, Cevik R, Karatay S, Erdal A, Baysal O et al (2010) Discrimination ability of ASDAS estimating disease activity status in patients with ankylosing spondylitis. Int J Rheum Dis 13(3):240–245
Machado P, Landewe R, Lie E, Kvien TK, Braun J, Baker D et al (2011) Ankylosing Spondylitis Disease Activity Score (ASDAS): defining cut-off values for disease activity states and improvement scores. Ann Rheum Dis 70(1):47–53
Sheehan NJ, Slavin BM, Donovan MP, Mount JN, Mathews JA (1986) Lack of correlation between clinical disease activity and erythrocyte sedimentation rate, acute phase proteins or protease inhibitors in ankylosing spondylitis. Br J Rheumatol 25(2):171–174
Ruof J, Stucki G (1999) Validity aspects of erythrocyte sedimentation rate and C-reactive protein in ankylosing spondylitis: a literature review. J Rheumatol 26(4):966–970
Spoorenberg A, van Tubergen A, Landewe R, Dougados M, van der Linden S, Mielants H et al (2005) Measuring disease activity in ankylosing spondylitis: patient and physician have different perspectives. Rheumatology (Oxford) 44(6):789–795
Spoorenberg A, van der Heijde D, de Klerk E, Dougados M, de Vlam K, Mielants H et al (1999) Relative value of erythrocyte sedimentation rate and C-reactive protein in assessment of disease activity in ankylosing spondylitis. J Rheumatol 26(4):980–984
Dougados M, Gueguen A, Nakache JP, Velicitat P, Zeidler H, Veys E et al (1999) Clinical relevance of C-reactive protein in axial involvement of ankylosing spondylitis. J Rheumatol 26(4):971–974
Eder L, Chandran V, Shen H, Cook RJ, Gladman DD (2010) Is ASDAS better than BASDAI as a measure of disease activity in axial psoriatic arthritis? Ann Rheum Dis 69(12):2160–2164
Rudwaleit M, Listing J, Brandt J, Braun J, Sieper J (2004) Prediction of a major clinical response (BASDAI 50) to tumour necrosis factor alpha blockers in ankylosing spondylitis. Ann Rheum Dis 63(6):665–670
Stone MA, Payne U, Pacheco-Tena C, Inman RD (2004) Cytokine correlates of clinical response patterns to infliximab treatment of ankylosing spondylitis. Ann Rheum Dis 63(1):84–87
Davis JC Jr, Van der Heijde DM, Dougados M, Braun J, Cush JJ, Clegg DO et al (2005) Baseline factors that influence ASAS 20 response in patients with ankylosing spondylitis treated with etanercept. J Rheumatol 32(9):1751–1754
Luc M, Gossec L, Ruyssen-Witrand A, Salliot C, Duclos M, Guignard S et al (2007) C-reactive protein predicts tumor necrosis factor-alpha blocker retention rate in axial ankylosing spondylitis. J Rheumatol 34(10):2078–2081
de Vries MK, van Eijk IC, van der Horst-Bruinsma IE, Peters MJ, Nurmohamed MT, Dijkmans BA et al (2009) Erythrocyte sedimentation rate, C-reactive protein level, and serum amyloid a protein for patient selection and monitoring of anti-tumor necrosis factor treatment in ankylosing spondylitis. Arthritis Rheum 61(11):1484–1490
Glintborg B, Ostergaard M, Krogh NS, Dreyer L, Kristensen HL, Hetland ML (2010) Predictors of treatment response and drug continuation in 842 patients with ankylosing spondylitis treated with anti-tumour necrosis factor: results from 8 years’ surveillance in the Danish nationwide DANBIO registry. Ann Rheum Dis 69(11):2002–2008
Acknowledgments
The author would like to acknowledge Queen Mary Hospital’s rheumatology team and clinical immunology division for their help in the study
Conflicts of interest
The author receives no financial support or has no financial interests in any of the devices or medications used use in this study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Au, Y.L.E., Wong, W.S.R., Mok, M.Y. et al. Disease activity assessment in ankylosing spondylitis in a Chinese cohort: BASDAI or ASDAS?. Clin Rheumatol 33, 1127–1134 (2014). https://doi.org/10.1007/s10067-014-2729-5
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-014-2729-5