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Defining functioning categories in axial Spondyloarthritis: the role of the ASAS Health Index

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Abstract

The Assessment of SpondyloArthritis international Society Health Index (ASAS HI) is an inclusive questionnaire, able to describe the total impairments and restrictions due to axial spondyloarthritis (axSpA). Considering the relationship between ASAS HI and the Ankylosing Spondylitis Disease Activity Score (ASDAS)-CRP, the aim of this study is to establish the ASAS HI cut-off values for functioning categories employing the ASDAS-CRP disease activity states in axSpA patients. ASAS HI and ASDAS-CPR were obtained from 140 consecutive axSpA patients, divided in the four ASDAS-CRP disease activity categories. High and very high disease activity were considered together. The ASAS HI cut-offs were obtained from the arithmetic mean, rounded off to the closest whole number, of the 75th percentile mean value of a lower rank and the 25th percentile mean value of the adjacent higher rank. This approach was applied in the transition from inactive disease and moderate disease activity, and in the transition from moderate disease activity and high/very high disease activity. Twenty-three patients were classified as having inactive disease, 36 were classified as having moderate disease activity, and 81 were in a high/very high disease activity state. Using the approach of the 75th–25th percentile mean values of adjacent disease activity states, the ASAS HI cut-offs resulted: ≤4 to dinstinguish a normal functioning, >4 and ≤8 to distinguish a moderate impairment of functioning, and >8 to distinguish a severe impairment of functioning. ASAS HI seems a reliable tool to define functioning categories in patients with axSpA.

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References

  1. Dougados M, Baeten D (2011) Spondyloarthritis. The Lancet 377:2127–2137

    Article  Google Scholar 

  2. Salaffi F, Carotti M, Gasparini S, Intorcia M, Grassi W (2009) The health-related quality of life in rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis: a comparison with a selected sample of healthy people. Health Qual Life Outcomes 7:25

    Article  PubMed  PubMed Central  Google Scholar 

  3. van Echteld I, Cieza A, Boonen A, Stucki G, Zochling J, Braun J et al (2006) Identification of the most common problems by patients with ankylosing spondylitis using the international classification of functioning, disability and health. J Rheumatol 33:2475–2483

    PubMed  Google Scholar 

  4. Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A (1994) A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 21:2286–2291

    CAS  PubMed  Google Scholar 

  5. Lukas C, Landewé R, Sieper J, Dougados M, Davis J, Braun J et al (2009) Developement of an ASAS-endorsed disease activity score (ASDAS) in patients with ankylosing spondylitis. Ann Rheum Dis 68:18–24

    Article  CAS  PubMed  Google Scholar 

  6. Machado PM, Landewé RB, 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 70:47–53

    Article  PubMed  Google Scholar 

  7. Calin A, Garrett S, Whitelock H, Kennedy LG, O’Hea J, Mallorie P et al (1994) A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol 21:2281–2285

    CAS  PubMed  Google Scholar 

  8. Doward LC, Spoorenberg A, Cook SA, Whalley D, Heliwell PS, Kay Lj 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 

  9. Kiltz U, van der Heijde D, Boonen A, Cieza A, Stucki G, Khan MA et al (2015) Developement 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 74:830–835

    Article  CAS  PubMed  Google Scholar 

  10. World Health Organization (2001) The international classification of functioning disability and health

  11. 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

    Article  PubMed  PubMed Central  Google Scholar 

  12. Rudwaleit M, Landewé R, van der Heijde D, Listing J, Brandt J, Braun J et al (2009) The developement of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part I): classification of paper patients by expert opinion including uncertainty appraisal. Ann Rheum Dis 68:770–776

    Article  CAS  PubMed  Google Scholar 

  13. Rudwaleit M, van der Heijde D, Landewé R, Listing J, Akkoc N, Brandt J et al (2009) The developement of Assessment of Spondyloarthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 68:777–783

    Article  CAS  PubMed  Google Scholar 

  14. The Assessment of SpondyloArthritis International Society (2015) The ASAS HI italian version. http://www.asas-group.org/clinicalinstruments/asas_health_index/asas_hi_italian.pdf

  15. Healey EL, Haywood KL, Jordan KP, Garratt A, Packham JC (2011) Impact of ankylosing spondylitis on work in patients across the UK. Scand J Rheumatol 40:34–40

    Article  CAS  PubMed  Google Scholar 

  16. Rudwaleit M, Haibel H, Baraliakos X, Listing J, Märker-Hermann E, Zeidler H et al (2009) The early disease stage in axial spondylarthritis: results from the German spondyloarthritis inception cohort. Arthritis Rheum 60:717–727

    Article  CAS  PubMed  Google Scholar 

  17. Boonen A, Braun J, van der Host Bruinsma IE et al (2010) ASAS/WHO ICF Core Sets for ankylosing spondylitis (AS): how to classify the impact of AS on functioning and health. Ann Rheum Dis 69:102–107

    Article  CAS  PubMed  Google Scholar 

  18. Schoels MM, Aletaha D, Alasti F, Smolen J (2016) Disease activity in psoriatic arthritis (PsA): defining remission and treatment success using the DAPSA score. Ann Rheum Dis 75:811–818

    Article  PubMed  Google Scholar 

  19. Machado PM. Measurements, composite scores and the art of (2016) ‘cutting-off’. Ann Rheum Dis 75:787–790

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Authors and Affiliations

  1. Rheumatology Department, Clinica Reumatologica, Polytechnic University of the Marche, c/o Ospedale “Carlo Urbani”, Via Aldo Moro, 25, 60035, Jesi, AN, Italy

    Marco Di Carlo, Valentina Lato, Andrea Di Matteo & Fausto Salaffi

  2. Radiology Department, Polytechnic University of the Marche, Ancona, Italy

    Marina Carotti

Authors
  1. Marco Di Carlo
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  2. Valentina Lato
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  3. Andrea Di Matteo
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  4. Marina Carotti
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  5. Fausto Salaffi
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Corresponding author

Correspondence to Marco Di Carlo.

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None.

Conflict of interest

FS has attended advisory board meetings and has received speaking fees from Bristol-Myers Squibb, Abbvie, Roche, Pfizer and Janssen. MC has attended advisory board meetings and has received speaking fees for Bristol-Myers Squibb, Abbvie and Janssen. MDC has attended advisory board meetings for Abbvie. VL and ADM declare that they have no conflict of interest.

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All the procedures in this work were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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

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  • DOI: https://doi.org/10.1007/s00296-016-3642-9

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