Skip to main content

Advertisement

SpringerLink
Log in

Performance characteristics of the simplified version of ankylosing spondylitis disease activity score (SASDAS)

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Various types of disease activity measures are available for axial spondyloarthritis (axSpA), and there is no gold standard for all individual patients. The ankylosing spondylitis disease activity score (ASDAS) is highly discriminatory, sensitive to change, and associated with structural progression. A simplified version of the ASDAS (SASDAS) was proposed and found to be a simple and practical tool to assess disease activity. Our aim was to test the performance characteristics of the SASDAS and compare it with validated tools. In total, 97 consecutive ankylosing spondylitis (AS) patients were included in the study. Disease activity was assessed by the ASDAS-erythrocyte sedimentation rate (ESR), ASDAS-C-reactive protein (CRP), bath ankylosing spondylitis disease activity index (BASDAI), and SASDAS. The relationship among these activity indices and the level of agreement of various activity categories were tested. There was a strong correlation between the SASDAS and other activity indices, including the BASDAI (r = 0.916, p < 0.001), ASDAS-CRP (r = 0.847, p < 0.001), and ASDAS-ESR (r = 0.942, p < 0.001). Although the agreement between the ASDAS-ESR and SASDAS was good (weighted kappa of 0.744 and total agreement of 77 %), there was moderate agreement between the ASDAS-CRP and SASDAS (weighted kappa of 0.579 and total agreement of 66 %). The disagreement was particularly striking in “moderate” and “high disease activity” states. Approximately 40 % of patients classified as moderate activity according to the ASDAS-ESR and 45 % according to the ASDAS-CRP were differentially categorized by the SASDAS. The results of the present analysis suggest that the simplified version of the ASDAS-ESR should be further validated in various settings and populations due to a questionable level of agreement between the ASDAS-CRP and SASDAS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Godfrin-Valnet M, Prati C, Puyraveau M, Toussirot E, Letho-Gyselink H, Wendling D (2013) Evaluation of spondylarthritis activity by patients and physicians: ASDAS, BASDAI, PASS, and flares in 200 patients. Joint Bone Spine 80:393–398

    Article  PubMed  Google Scholar 

  2. Salaffi F, Ciapetti A, Carotti M, Gasparini S, Citera G, Gutierrez M (2014) Construct validity and responsiveness of the simplified version of Ankylosing Spondylitis Disease Activity Score (SASDAS) for the evaluation of disease activity in axial spondyloarthritis. Health Qual Life Outcomes 12:129

    Article  PubMed  PubMed Central  Google Scholar 

  3. Machado P, Landewe R (2013) Spondyloarthritis: is it time to replace BASDAI with ASDAS? Nat Rev Rheumatol 9:388–390

    Article  PubMed  Google Scholar 

  4. Lukas C, Landewe R, Sieper J et al (2009) Development of an ASAS-endorsed disease activity score (ASDAS) in patients with ankylosing spondylitis. Ann Rheum Dis 68:18–24

    Article  CAS  PubMed  Google Scholar 

  5. van der Heijde D, Lie E, Kvien TK et al (2009) ASDAS, a highly discriminatory ASAS-endorsed disease activity score in patients with ankylosing spondylitis. Ann Rheum Dis 68:1811–1818

    Article  PubMed  Google Scholar 

  6. Machado PM, Raychaudhuri SP (2009) Disease activity measurements and monitoring in psoriatic arthritis and axial spondyloarthritis. Best Pract Res Clin Rheumatol 28:711–728

    Article  Google Scholar 

  7. Kilic G, Kilic E, Nas K et al (2015) Comparison of ASDAS and BASDAI as a measure of disease activity in axial psoriatic arthritis. Clin Rheumatol 34:515–521. doi:10.1007/s10067-014-2734-8

    Article  PubMed  Google Scholar 

  8. Au YL, Wong WS, Mok MY, Chung HY, Chan E, Lau CS (2014) Disease activity assessment in ankylosing spondylitis in a Chinese cohort: BASDAI or ASDAS? Clin Rheumatol 33:1127–1134. doi:10.1007/s10067-014-2729-5

    Article  PubMed  Google Scholar 

  9. Popescu C, Trandafir M, Badica A, Morar F, Predeteanu D (2014) Ankylosing spondylitis functional and activity indices in clinical practice. J Med Life 7:78–83

    CAS  PubMed  PubMed Central  Google Scholar 

  10. Fernandez-Espartero C, de Miguel E, Loza E et al (2014) Validity of the ankylosing spondylitis disease activity score (ASDAS) in patients with early spondyloarthritis from the Esperanza programme. Ann Rheum Dis 73:1350–1355

    Article  PubMed  Google Scholar 

  11. Fagerli KM, Lie E, van der Heijde DE et al (2012) Selecting patients with ankylosing spondylitis for TNF inhibitor therapy: comparison of ASDAS and BASDAI eligibility criteria. Rheumatology (Oxford) 51:1479–1483

    Article  CAS  Google Scholar 

  12. Xu M, Lin Z, Deng X et al (2011) The Ankylosing Spondylitis Disease Activity Score is a highly discriminatory measure of disease activity and efficacy following tumour necrosis factor-alpha inhibitor therapies in ankylosing spondylitis and undifferentiated spondyloarthropathies in China. Rheumatology (Oxford) 50:1466–1472

    Article  CAS  Google Scholar 

  13. Aydin SZ, Can M, Atagunduz P, Direskeneli H (2010) Active disease requiring TNF-alpha-antagonist therapy can be well discriminated with different ASDAS sets: a prospective, follow-up of disease activity assessment in ankylosing spondylitis. Clin Exp Rheumatol 28:752–755

    CAS  PubMed  Google Scholar 

  14. Nas K, Yildirim K, Cevik R et al (2010) Discrimination ability of ASDAS estimating disease activity status in patients with ankylosing spondylitis. Int J Rheum Dis 13:240–245

    Article  PubMed  Google Scholar 

  15. 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 69:2160–2164

    Article  PubMed  Google Scholar 

  16. Sommerfleck FA, Schneeberger EE, Buschiazzo EE, Maldonado Cocco JA, Citera G (2012) A simplified version of Ankylosing Spondylitis Disease Activity Score (ASDAS) in patients with ankylosing spondylitis. Clin Rheumatol 31:1599–1603. doi:10.1007/s10067-012-2056-7

    Article  PubMed  Google Scholar 

  17. 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

    Article  PubMed  Google Scholar 

  18. Akad K, Solmaz D, Sari I, Onen F, Akkoc N, Akar S (2013) Performance of response scales of activity and functional measures of ankylosing spondylitis: numerical rating scale versus visual analog scale. Rheumatol Int 33:2617–2623. doi:10.1007/s00296-013-2789-x

    Article  PubMed  Google Scholar 

  19. Daltroy LH, Larson MG, Roberts NW, Liang MH (1990) A modification of the Health Assessment Questionnaire for the spondyloarthropathies. J Rheumatol 17:946–950

    CAS  PubMed  Google Scholar 

  20. Doward LC, Spoorenberg A, Cook SA et al (2003) Development of the ASQoL: a quality of life instrument specific to ankylosing spondylitis. Ann Rheum Dis 62:20–26

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Jenkinson TR, Mallorie PA, Whitelock HC, Kennedy LG, Garrett SL, Calin A (1994) Defining spinal mobility in ankylosing spondylitis (AS). The Bath AS Metrology Index. J Rheumatol 21:1694–1698

    CAS  PubMed  Google Scholar 

  22. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  CAS  PubMed  Google Scholar 

  23. Machado P, van der Heijde D (2011) How to measure disease activity in axial spondyloarthritis? Curr Opin Rheumatol 23:339–345. doi:10.1097/BOR.0b013e3283470f23

    Article  PubMed  Google Scholar 

  24. Machado P, Landewe R, Lie E et al (2011) Ankylosing Spondylitis Disease Activity Score (ASDAS): defining cut-off values for disease activity states and improvement scores. Ann Rheum Dis 70:47–53

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

None.

Author information

Authors and Affiliations

  1. Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Namik Kemal University Hospital, Tekirdag, Turkey

    Dilek Solmaz & Okan Avci

  2. Faculty of Medicine, Department of Physiotherapy and Rehabilitation, Namik Kemal University Hospital, Tekirdag, Turkey

    Tulay Yildirim

  3. Izmir Ataturk Research and Training Hospital, Izmir Katip Celebi University, Izmir, Turkey

    Nazmiye Tomas

  4. Department of Internal Medicine, Division of Rheumatology, Izmir Katip Celebi University School of Medicine, Izmir, Turkey

    Servet Akar

Authors
  1. Dilek Solmaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tulay Yildirim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Okan Avci
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nazmiye Tomas
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Servet Akar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Servet Akar.

Ethics declarations

Compliance with ethical standards

This study was approved by the local ethics committee, and all patients gave written informed consent.

Disclosures

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Solmaz, D., Yildirim, T., Avci, O. et al. Performance characteristics of the simplified version of ankylosing spondylitis disease activity score (SASDAS). Clin Rheumatol 35, 1753–1758 (2016). https://doi.org/10.1007/s10067-015-3147-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-015-3147-z

Keywords

Search

Navigation