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46. Kongress der Deutschen Gesellschaft für Rheumatologie (DGRh), 32. Jahrestagung der Deutschen Gesellschaft für Orthopädische Rheumatologie (DGORh), Wissenschaftliche Herbsttagung der Gesellschaft für Kinder- und Jugendrheumatologie (GKJR)

19.09. - 22.09.2018, Mannheim

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Ankylosing Spondylitis Disease Activity Score (ASDAS) based on a quick quantitative CRP-assay performs similarly well to ASDAS based on conventional CRP in patients with axial spondyloarthritis

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  • Fabian Proft - Charité – Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie, Rheumatologie, Berlin
  • Burkhard Muche - Charité – Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie, Rheumatologie, Berlin
  • Laura Spiller - Charité – Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie, Rheumatologie, Berlin
  • Valeria Rios Rodriguez - Charité – Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie, Rheumatologie, Berlin
  • Judith Rademacher - Charité – Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie, Rheumatologie, Berlin
  • Anne-Katrin Weber - Charité – Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie, Rheumatologie, Berlin
  • Susanne Lüders - Charité – Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie, Rheumatologie, Berlin
  • Mikhail Protopopov - Charité – Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie, Rheumatologie, Berlin
  • Inge Spiller - Charité – Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie, Rheumatologie, Berlin
  • Joachim Sieper - Charité – Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie, Rheumatologie, Berlin
  • Denis Poddubnyy - Charité – Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie, Rheumatologie, Berlin

Deutsche Gesellschaft für Rheumatologie. Deutsche Gesellschaft für Orthopädische Rheumatologie. Gesellschaft für Kinder- und Jugendrheumatologie. 46. Kongress der Deutschen Gesellschaft für Rheumatologie (DGRh), 32. Jahrestagung der Deutschen Gesellschaft für Orthopädische Rheumatologie (DGORh), Wissenschaftliche Herbsttagung der Gesellschaft für Kinder- und Jugendrheumatologie (GKJR). Mannheim, 19.-22.09.2018. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocSpA.20

doi: 10.3205/18dgrh162, urn:nbn:de:0183-18dgrh1627

Published: February 5, 2019

© 2019 Proft et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Background: The Ankylosing Spondylitis Disease Activity Score (ASDAS) is a composite index to assess disease activity in patients with axial spondyloarthritis (axSpA). According to the treat-to-target (T2T) recommendations for SpA, and the ASAS/EULAR management recommendations for axSpA, the C-reactive protein (CRP)-based ASDAS is the preferred instrument for the assessment of disease activity in the process of making decision on modification of axSpA treatment in clinical routine. Currently, measurement of CRP by routine lab methods takes hours to days what seriously challenges the feasibility of T2T approaches in clinicalroutine and clinical studies. The objective of this studywas to compare the performance of the ASDAS based on a quickCRP assay (ASDAS-quick-CRP) with the ASDAS-routine-CRP and with the erythrocyte sedimentation rate (ESR)-based ASDAS in the assessment of disease activity in patients with axSpA.

Methods: This cross-sectional study was performed in patients referred with a suspicion of axSpA as part of the Identification of the Optimal Referral Strategy for Early Diagnosis of Axial Spondyloarthritis (OptiRef) study. Briefly, referred patients underwent a structured assessment of SpA features by a rheumatologist. CRP was measured in the central lab (routine turbidimetric assay, lowest detection level: 0.3 mg/l) and locally by ESR and a quantitative quick-CRP test (QuickRead go®, Orion Diagnostica Oy, lowest detection level: 5mg/l, test duration approx. 2 min.). If the quick-CRP was below the limit of detection, the value of 2 mg/l was used. In patients with the final diagnosis of axSpA, ASDAS-routine-CRP, ASDAS-quick-CRP and ASDAS-ESR were calculated.

Results: A total of 132 patients referred with suspicion of axSpA had available routine and quick CRP levels; 46 patients of them were diagnosed with axSpA. Mean±SD routine / quick CRP serum levels were 3.20±6.86 mg/l and 4.52±6.78 mg/l, respectively, in the entire group, and 7.09±10.18 mg/l and 8.22±10.11 mg/l, respectively, in patients with axSpA. There was no significant difference (p=0.11) in the mean values of ASDAS-CRP (2.76±0.97) and ASDAS-quick-CRP (2.80±1.00), while the ASDAS-ESR (2.90±1.02) was significantly higher than ASDAS-routine-CRP (p=0.034). In 43 of the 46 cases of axSpA (94%) the status scores for disease activity showed no difference between ASDAS-routine-CRP and ASDAS-quick-CRP – figure. Two patients were assigned to a higher and one to a lower disease activity category (DAC) according to ASDAS-quick-CRP as compared to ASDAS-routine-CRP. For ASDAS-ESR compared to ASDAS-routine-CRP, only 32/44 patients (73%) were assigned to the same DAC (Figure 1 [Fig. 1]).

Conclusion: ASDAS-quick-CRP performed similarly well to ASDAS-routine-CRP with an agreement on the status score for disease activity of 94%, that was clearly better than the agreement of 73% between ASDAS-ESR and ASDAS-routine-CRP. With a duration of approximately 2 minutes the quick-CRP test is, therefore, feasible for immediate decision making as a part of clinical routine or clinical trials.