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42. Kongress der Deutschen Gesellschaft für Rheumatologie, 28. Jahrestagung der Deutschen Gesellschaft für Orthopädische Rheumatologie, 24. Wissenschaftliche Jahrestagung der Gesellschaft für Kinder- und Jugendrheumatologie

17.-20. September 2014, Düsseldorf

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Different performance of the major disease activity measures ASDAS and BASDAI in patients with axial spondyloarthritis treated with non-steroidal anti-inflammatory agents – results from a prospective study

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  • Xenofon Baraliakos - Rheumazentrum Ruhrgebiet, St. Josefs-Krankenhaus, Herne
  • Uta Kiltz - Rheumazentrum Ruhrgebiet, St. Josefs-Krankenhaus, Herne
  • Frank Heldmann - Rheumazentrum Ruhrgebiet, St. Josefs-Krankenhaus, Herne
  • Heiner Appel - Charité - Universitätsmedizin Berlin, Rheumatologie, Berlin
  • Friedrich Dybowski - Rheumapraxis Ruhr, Herne
  • Manfred Igelmann - Praxis, Bochum
  • Ludwig Kalthoff - Internistisch-Rheumatologische Schwerpunktpraxis, Herne
  • Dietmar M. J. Krause - Internistische und rheumatologische Gemeinschaftspraxis, Gladbeck
  • Hans-Jürgen Menne - Praxis, Dortmund
  • Ertan Saracbasi-Zender - Rheumazentrum Ruhrgebiet, St. Josefs-Krankenhaus, Herne
  • Elmar Schmitz-Bortz - Rheumatologische und Osteologische Schwerpunktpraxis Hattingen, Hattingen
  • Jürgen Braun - Rheumazentrum Ruhrgebiet, St. Josefs-Krankenhaus, Herne

Deutsche Gesellschaft für Rheumatologie. Deutsche Gesellschaft für Orthopädische Rheumatologie. Gesellschaft für Kinder- und Jugendrheumatologie. 42. Kongress der Deutschen Gesellschaft für Rheumatologie (DGRh); 28. Jahrestagung der Deutschen Gesellschaft für Orthopädische Rheumatologie (DGORh); 24. wissenschaftliche Jahrestagung der Gesellschaft für Kinder- und Jugendrheumatologie (GKJR). Düsseldorf, 17.-20.09.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocSP.08

doi: 10.3205/14dgrh241, urn:nbn:de:0183-14dgrh2410

Published: September 12, 2014

© 2014 Baraliakos et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Introduction: Measures for disease activity (BASDAI, ASDAS) are routinely used in patients (pts) with axial spondyloarthritis (axSpA). There are no data on the comparison of ASDAS and BASDAI in axSpA pts treated with NSAIDs.

Methods: Consecutive patients (pts) with axSpA (n=50 nr-axSpA, n=50 AS) were prospectively included if BASDAI was ≥4, had not yet received the maximally approved NSAID dose and had not been treated with anti-TNF yet. The maximal dose of NSAIDs was administered over 1wk and was then adapted in case of BASDAI<4. In case of BASDAI≥4, the NSAID was changed and pt was treated for another 3 wk at the maximal dose. Clinical and laboratory parameters were assessed and the dosage of NSAIDs was quantified by using the ASAS-index. Data were collected before (BL) and after 1 and 4 wks of NSAID treatment.

Results: Baseline characteristics of AS and nr-axSpA patients were similar. Prior to treatment, ASDAS >2.1 was found in 74% and 76% of pts with AS and nr-axSpA, respectively. There was a significant decrease in both, ASDAS (BL: 2.5±0.6, 1wk: 1.9±0.8, 4wk: 1.6±0.8) and BASDAI (BL: 5.8±1.3 1wk: 4.1±2.1 4wk: 2.1±3.1). However, at wk 4 a BASDAI ≥4 was still present in 34% axSpA pts, but only 15% of these had an ASDAS <2.1. Another 33% of pts had an ASDAS <2.1 but only 4% of those had a BASDAI <4. This difference was much more prominent in nr-axSpA patients. In the univariate logistic regression analysis both, ASDAS (OR: 3.6, p=0.002) and BASDAI (OR: 1.8, p=0.001) predicted the eligibility for anti-TNF therapy after 4wk of NSAIDs at BL, ASDAS performed superior to BASDAI.

Conclusion: BASDAI and ASDAS showed a similar magnitude of response on NSAID treatment in both AS and nr-axSpA. Of interest, the discriminative power of the ASDAS was much clearer in patients classified as nr-axSpA and especially in those who could be considered as candidates for anti-TNF treatment. These data challenge the concept of only using the BASDAI cut-off ≥4 for such treatment decisions.