Skip to main content

Advertisement

SpringerLink
Log in

How to Monitor Disease Activity of Axial Spondyloarthritis in Clinical Practice

  • Review
  • Published:
Current Rheumatology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Treatment guided by periodic and quantitative data assessment results in better outcomes compared to using clinical gestalt. While validated generic as well as specific disease activity measures for axial spondyloarthritis (axSpA) are available, there is vast scope to improve their actual utilization in routine clinical practice. In this review, we discuss available disease activity measures for axSpA, describe results from the survey conducted among general rheumatologists as well as Spondyloarthritis Research and Treatment Network (SPARTAN) members about disease activity measurement in daily practice, and discuss ways to improve axSpA disease activity using technological advances. We also discuss the definitions of active disease and target for the treatment of axSpA.

Recent Findings

The 2019 American College of Rheumatology (ACR)/Spondylitis Association of America (SAA)/Spondyloarthritis Research and Treatment Network (SPARTAN) axSpA treatment guidelines conditionally recommend the regular monitoring of disease activity using a validated measure such as Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) or Ankylosing Spondylitis Disease Severity Index (ASDAS). Assessment of Spondyloarthritis International Society (ASAS)-European Alliance of Associations for Rheumatology (EULAR) guidelines recommend ASDAS as the most appropriate instrument for the assessment of disease activity, preferably calculated using C-reactive protein (CRP). ASAS has selected a core set of variables which were updated recently and have been endorsed by the Outcome Measures in Rheumatology Clinical Trials (OMERACT) group in order to bring homogeneity in assessment of axSpA. In a recent study, Patient-Reported Outcomes Measurement Information System (PROMIS®) measures were able to discriminate inactive, moderate, and high–very high ASDAS activity groups. A newly developed semi-objective index P4 (pain, physical function, patient global, and physician global) correlates well with BASDAI and ASDAS in axSpA and can also be used for other rheumatic diseases in busy clinical practices.

Summary

Regular disease activity monitoring is critical for long-term management of axSpA and shared decision-making. The integration of electronic health records and smart devices provides a great opportunity to capture patient-reported data. Automated capture of electronic patient-reported outcome measures (ePROMs) is a highly efficient way and results in consistent regular monitoring and may improve the long-term outcomes. While currently used measures focus only on musculoskeletal symptoms of axSpA, a composite disease activity measure that can also incorporate extra-articular manifestations may provide a better assessment of disease activity.

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
Fig. 2
Fig. 3

Similar content being viewed by others

Data Availability

No datasets were generated or analyzed during the current study.

References

  1. Sieper J, Poddubnyy D. Axial spondyloarthritis. Lancet. 2017;390(10089):73–84.

    Article  PubMed  Google Scholar 

  2. Navarro-Compán V, Sepriano A, El-Zorkany B, van der Heijde D. Axial spondyloarthritis. Ann Rheum Dis. 2021;80(12):1511–21.

    Article  PubMed  Google Scholar 

  3. Sørensen J, Hetland ML. Diagnostic delay in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis: results from the Danish nationwide DANBIO registry. Ann Rheum Dis. 2015;74(3):e12-e.

    Article  Google Scholar 

  4. Redeker I, Callhoff J, Hoffmann F, Haibel H, Sieper J, Zink A, et al. Determinants of diagnostic delay in axial spondyloarthritis: an analysis based on linked claims and patient-reported survey data. Rheumatology. 2019;58(9):1634–8.

    Article  PubMed  Google Scholar 

  5. Poddubnyy D, Protopopov M, Haibel H, Braun J, Rudwaleit M, Sieper J. High disease activity according to the Ankylosing Spondylitis Disease Activity Score is associated with accelerated radiographic spinal progression in patients with early axial spondyloarthritis: results from the GErman SPondyloarthritis Inception Cohort. Ann Rheum Dis. 2016;75(12):2114–8.

    Article  PubMed  Google Scholar 

  6. Taurog JD, Chhabra A, Colbert RA. Ankylosing spondylitis and axial spondyloarthritis. N Engl J Med. 2016;374(26):2563–74.

    Article  PubMed  Google Scholar 

  7. Ward MM, Deodhar A, Gensler LS, Dubreuil M, Yu D, Khan MA, et al. 2019 Update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research And Treatment Network recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis. Arthritis Rheumatol. 2019;71(10):1599–613.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Ramiro S, Nikiphorou E, Sepriano A, Ortolan A, Webers C, Baraliakos X, et al. ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update. Ann Rheum Dis. 2023;82(1):19–34.

    Article  PubMed  Google Scholar 

  9. Nam EJ, Lee WK. Early achievement of ASDAS clinical response is associated with long-term improvements in metrological outcomes in patients with ankylosing spondylitis treated with TNF-α blockers. Medicine (Baltimore). 2020;99(41):e22668. https://doi.org/10.1097/MD.0000000000022668.

  10. Dougados M, Lucas J, Desfleurs E, Lukas C, Saraux A, Tournadre A, et al. Impact of disease activity outcome measures reporting in the medical records of patients with axial spondyloarthritis on the retention rates of biological treatment: the example of secukinumab use in daily practice in France. RMD Open. 2022;8(1): e002106.

    Article  PubMed  PubMed Central  Google Scholar 

  11. van der Heijde DMFM, Van’t Hof MA, Van Riel PL, Van Leeuwen MA, Van Rijswijk MH, Van de Putte LB. Validity of single variables and composite indices for measuring disease activity in rheumatoid arthritis. Ann Rheum Dis. 1992;51(2):177–81.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Machado PM, Raychaudhuri SP. Disease activity measurements and monitoring in psoriatic arthritis and axial spondyloarthritis. Best Pract Res Clin Rheumatol. 2014;28(5):711–28.

    Article  PubMed  Google Scholar 

  13. Sieper J, Rudwaleit M, Baraliakos X, Brandt J, Braun J, Burgos-Vargas R, et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis. 2009;68(Suppl):1ii1-44.

    Google Scholar 

  14. Navarro-Compán V, Boel A, Boonen A, Mease P, Landewé R, Kiltz U, Dougados M, Baraliakos X, Bautista-Molano W, Carlier H, Chiowchanwisawakit P, Dagfinrud H, de Peyrecave N, El-Zorkany B, Fallon L, Gaffney K, Garrido-Cumbrera M, Gensler LS, Haroon N, Kwan YH, Machado PM, Maksymowych WP, Poddubnyy D, Protopopov M, Ramiro S, Shea B, Song IH, van Weely S, van der Heijde D. The ASAS-OMERACT core domain set for axial spondyloarthritis. Semin Arthritis Rheum. 2021;51(6):1342–1349. https://doi.org/10.1016/j.semarthrit.2021.07.021.

  15. Machado P, van der Heijde D. How to measure disease activity in axial spondyloarthritis? Curr Opin Rheumatol. 2011;23(4):339–45.

    Article  PubMed  Google Scholar 

  16. Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A. A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol. 1994;21(12):2286–91.

    CAS  PubMed  Google Scholar 

  17. Akkoc Y, Karatepe AG, Akar S, Kirazli Y, Akkoc N. A Turkish version of the bath ankylosing spondylitis disease activity index: reliability and validity. Rheumatol Int. 2005;25:280–4.

    Article  PubMed  Google Scholar 

  18. Park H-J, Kim S, Lee J-E, Jun J-B, Bae S-C. The reliability and validity of a Korean translation of the BASDAI in Korean patients with ankylosing spondylitis. Value Health. 2008;11:S99–104.

    Article  PubMed  Google Scholar 

  19. Bidad K, Fallahi S, Mahmoudi M, Jamshidi A, Farhadi E, Meysamie A, et al. Evaluation of the Iranian versions of the bath ankylosing spondylitis disease activity index (BASDAI), the bath ankylosing spondylitis functional index (BASFI) and the patient acceptable symptom state (PASS) in patients with ankylosing spondylitis. Rheumatol Int. 2012;32:3613–8.

    Article  PubMed  Google Scholar 

  20. Machado P, Landewé R, Lie E, Kvien TK, Braun J, Baker D, et al. Ankylosing Spondylitis Disease Activity Score (ASDAS): defining cut-off values for disease activity states and improvement scores. Ann Rheum Dis. 2011;70(1):47–53.

    Article  PubMed  Google Scholar 

  21. Van Der Heijde D, Ramiro S, Landewé R, Baraliakos X, Van den Bosch F, Sepriano A, et al. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis. 2017;76(6):978–91.

    Article  PubMed  Google Scholar 

  22. Kwon OC, Park M-C. BASDAI cut-off values corresponding to ASDAS cut-off values. Rheumatology. 2022;61(6):2369–74.

    Article  PubMed  Google Scholar 

  23. van Almod R, Carmona L, Zarco P, Collantes E, Gonzlez C, Mulero J, et al. Fibromyalgia in patients with ankylosing spondylitis: prevalence and utility of the measures of activity, function and radiological damage. Clin Exp Rheumatol Suppl. 2010;28(6):S33.

    Google Scholar 

  24. Mease PJ. Fibromyalgia, a missed comorbidity in spondyloarthritis: prevalence and impact on assessment and treatment. Curr Opin Rheumatol. 2017;29(4):304–10.

    Article  PubMed  Google Scholar 

  25. Lukas C, Landewé R, Sieper J, Dougados M, Davis J, Braun J, et al. Development of an ASAS-endorsed disease activity score (ASDAS) in patients with ankylosing spondylitis. Ann Rheum Dis. 2009;68(1):18–24.

    Article  CAS  PubMed  Google Scholar 

  26. Machado PM, Landewé R, van der Heijde D. Ankylosing Spondylitis Disease Activity Score (ASDAS): 2018 update of the nomenclature for disease activity states. Ann Rheum Dis. 2018;77(10):1539–40.

    Article  PubMed  Google Scholar 

  27. Xu M, Lin Z, Deng X, Li L, Wei Y, Liao Z, et al. The Ankylosing Spondylitis Disease Activity Score is a highly discriminatory measure of disease activity and efficacy following tumour necrosis factor-α inhibitor therapies in ankylosing spondylitis and undifferentiated spondyloarthropathies in China. Rheumatology. 2011;50(8):1466–72.

    Article  CAS  PubMed  Google Scholar 

  28. Fernández-Espartero C, De Miguel E, Loza E, Tomero E, Gobbo M, Descalzo MA, et al. Validity of the ankylosing spondylitis disease activity score (ASDAS) in patients with early spondyloarthritis from the Esperanza programme. Ann Rheum Dis. 2014;73(7):1350–5.

    Article  PubMed  Google Scholar 

  29. Kilic E, Kilic G, Akgul O, Ozgocmen S. Discriminant validity of the Ankylosing Spondylitis Disease Activity Score (ASDAS) in patients with non-radiographic axial spondyloarthritis and ankylosing spondylitis: a cohort study. Rheumatol Int. 2015;35:981–9.

    Article  PubMed  Google Scholar 

  30. Sepriano A, Ramiro S, Wichuk S, Chiowchanwisawakit P, Paschke J, van der Heijde D, et al. Disease activity is associated with spinal radiographic progression in axial spondyloarthritis independently of exposure to tumour necrosis factor inhibitors. Rheumatology. 2021;60(1):461–2.

    Article  PubMed  Google Scholar 

  31. Wach J, Letroublon M-C, Coury F, Tebib JG. Fibromyalgia in spondyloarthritis: effect on disease activity assessment in clinical practice. J Rheumatol. 2016;43(11):2056–63.

    Article  CAS  PubMed  Google Scholar 

  32. Kempin R, Richter JG, Schlegel A, Baraliakos X, Tsiami S, Buehring B, et al. Monitoring of disease activity with a smartphone app in routine clinical care in patients with axial spondyloarthritis. J Rheumatol. 2022;49(8):878–84.

    Article  PubMed  Google Scholar 

  33. Danve A, Deodhar A. Treatment of axial spondyloarthritis: an update. Nat Rev Rheumatol. 2022;18(4):205–16.

    Article  PubMed  Google Scholar 

  34. Pincus T, Swearingen CJ, Bergman M, Yazici Y. RAPID3 (Routine Assessment of Patient Index Data 3), a rheumatoid arthritis index without formal joint counts for routine care: proposed severity categories compared to disease activity score and clinical disease activity index categories. J Rheumatol. 2008;35(11):2136–47.

    Article  PubMed  Google Scholar 

  35. Danve A, Reddy A, Vakil-Gilani K, Garg N, Dinno A, Deodhar A. Routine Assessment of Patient Index Data 3 score (RAPID3) correlates well with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in the assessment of disease activity and monitoring progression of axial spondyloarthritis. Clin Rheumatol. 2015;34:117–24.

    Article  PubMed  Google Scholar 

  36. Park S-H, Choe J-Y, Kim S-K, Lee H, Castrejón I, Pincus T. Routine Assessment of Patient Index Data (RAPID3) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores yield similar information in 85 Korean patients with ankylosing spondylitis seen in usual clinical care. J Clin Rheumatol. 2015;21(6):300.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Castrejón I, Pincus T, Wendling D, Dougados M. Responsiveness of a simple RAPID-3-like index compared to disease-specific BASDAI and ASDAS indices in patients with axial spondyloarthritis. RMD Open. 2016;2(2): e000235.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Danve A, Hsiao B, Zhang P. P4 Index Correlates with RAPID3 and Disease-Specific Indices in Rheumatoid Arthritis (RA) and Axial Spondyloarthritis (axSpA) [abstract]. Arthritis Rheumatol. 2020;72 Suppl 10. https://acrabstracts.org/abstract/p4-index-correlates-with-rapid3-and-disease-specific-indices-in-rheumatoid-arthritis-ra-and-axial-spondyloarthritis-axspa/. Accessed 14 Feb 2024

  39. Cella D, Yount S, Rothrock N, Gershon R, Cook K, Reeve B, et al. The Patient-Reported Outcomes Measurement Information System (PROMIS): progress of an NIH roadmap cooperative group during its first two years. Med Care. 2007;45(5 Suppl 1):S3-s11.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Hwang MC, Ogdie A, Puravath A, Reveille JD. Reliability and validity of patient-reported outcomes measurement information system short forms in ankylosing spondylitis. J Rheumatol. 2020;47(8):1182–8.

    Article  PubMed  Google Scholar 

  41. Hamilton L, Barkham N, Bhalla A, Brittain R, Cook D, Jones G, et al. BSR and BHPR guideline for the treatment of axial spondyloarthritis (including ankylosing spondylitis) with biologics. Rheumatology. 2017;56(2):313–6.

    Article  PubMed  Google Scholar 

  42. Salaffi F, Gasparini S, Ciapetti A, Gutierrez M, Grassi W. Usability of an innovative and interactive electronic system for collection of patient-reported data in axial spondyloarthritis: comparison with the traditional paper-administered format. Rheumatology. 2013;52(11):2062–70.

    Article  PubMed  Google Scholar 

  43. Kiltz U, Boonen A, Braun J, Richter JG. Electronic assessment of disease activity and functioning in patients with axial spondyloarthritis: challenges and unmet needs. Clin Exp Rheumatol. 2016;34(Suppl 101):S57–61.

    PubMed  Google Scholar 

  44. Kwan YH, Ong WJ, Xiong M, Leung YY, Phang JK, Wang CTM, et al. Evaluation of mobile apps targeted at patients with spondyloarthritis for disease monitoring: systematic app search. JMIR Mhealth Uhealth. 2019;7(10): e14753.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Webers C, Beckers E, Boonen A, van Eijk-Hustings Y, Vonkeman H, Van De Laar M, et al. Development, usability and acceptability of an integrated eHealth system for spondyloarthritis in the Netherlands (SpA-Net). RMD Open. 2019;5(1): e000860.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Liew JW, Dubreuil M. Treat to target in axial spondyloarthritis: pros, cons, and future directions. Rheum Dis Clin. 2020;46(2):343–56.

    Article  Google Scholar 

  47. Gossec L, Guyard F, Leroy D, Lafargue T, Seiler M, Jacquemin C, et al. Detection of flares by decrease in physical activity, collected using wearable activity trackers in rheumatoid arthritis or axial spondyloarthritis: an application of machine learning analyses in rheumatology. Arth Car & Res. 2019;71(10):1336–43.

    Article  Google Scholar 

  48. Jacquemin C, Molto A, Servy H, Sellam J, Foltz V, Gandjbakhch F, et al. Flares assessed weekly in patients with rheumatoid arthritis or axial spondyloarthritis and relationship with physical activity measured using a connected activity tracker: a 3-month study. RMD Open. 2017;3(1): e000434.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Jacquemin C, Servy H, Molto A, Sellam J, Foltz V, Gandjbakhch F, et al. Physical activity assessment using an activity tracker in patients with rheumatoid arthritis and axial spondyloarthritis: prospective observational study. JMIR Mhealth Uhealth. 2018;6(1): e1.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Machado P, Landewé RBM, Braun J, Baraliakos X, Hermann K-GA, Hsu B, et al. MRI inflammation and its relation with measures of clinical disease activity and different treatment responses in patients with ankylosing spondylitis treated with a tumour necrosis factor inhibitor. Ann Rheum Dis. 2012;71(12):2002–5.

    Article  PubMed  Google Scholar 

  51. Navarro-Compán V, Ramiro S, Landewé R, Dougados M, Miceli-Richard C, Richette P, et al. Disease activity is longitudinally related to sacroiliac inflammation on MRI in male patients with axial spondyloarthritis: 2-years of the DESIR cohort. Ann Rheum Dis. 2016;75(5):874–8.

    Article  PubMed  Google Scholar 

  52. Navarro-Compán V, Ramiro S, Landewé R, Dougados M, Miceli-Richard C, Richette P, et al. In patients with axial spondyloarthritis, inflammation on MRI of the spine is longitudinally related to disease activity only in men: 2 years of the axial spondyloarthritis DESIR cohort. Ann Rheum Dis. 2018;77(3):470–2.

    Article  PubMed  Google Scholar 

  53. Falcao S, Castillo-Gallego C, Peiteado D, Branco J, Martín Mola E, de Miguel E. Can we use enthesis ultrasound as an outcome measure of disease activity in spondyloarthritis? A study at the Achilles level. Rheumatology. 2015;54(9):1557–62.

    Article  CAS  PubMed  Google Scholar 

  54. Deodhar A, Kumthekar A, Dubreuil M. Minimal disease activity in axial spondyloarthritis: the need of the hour and a proposal for development. Curr Opin Rheumatol. 2017;29(4):293.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Rheumatology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, New York, NY, USA

    Anand Kumthekar

  2. Department of Medicine, Westchester Medical Center, Valhalla, NY, USA

    Nirali Sanghavi

  3. Seth G S Medical College, Mumbai, India

    Anuya Natu

  4. Division of Rheumatology, Department of Medicine, Yale School of Medicine, New Haven, CT, USA

    Abhijeet Danve

Authors
  1. Anand Kumthekar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nirali Sanghavi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anuya Natu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Abhijeet Danve
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Anand Kumthekar and Abhijeet Danve conceptualized the review and prepared as well as modified the manuscript. Anuya Natu and Nirali Sanghavi did literature search and prepared table and draft of the manuscript. All authors reviewed the manuscript.

Corresponding author

Correspondence to Abhijeet Danve.

Ethics declarations

Conflict of Interest

Abhijeet Danve received research grants from Novartis and Eli Lilly; is a member of advisory boards for Janssen, AbbVie, Amgen, and Novartis; and is a speaker for Amgen and Janssen. All other authors declare no competing interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This manuscript is published thanks to collaboration with the SPARTAN group.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This manuscript is published thanks to collaboration with the SPARTAN group.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kumthekar, A., Sanghavi, N., Natu, A. et al. How to Monitor Disease Activity of Axial Spondyloarthritis in Clinical Practice. Curr Rheumatol Rep 26, 170–177 (2024). https://doi.org/10.1007/s11926-024-01141-0

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11926-024-01141-0

Keywords

Search

Navigation