ASDAS vs BASDAI Score: Predicting Biologic Treatment Response in Axial Spondyloarthritis With Coexistent Fibromyalgia

The following article is a part of conference coverage from the 2019 American College of Rheumatology/Association of Rheumatology Professionals (ACR/ARP) Annual Meeting, being held in Atlanta, Georgia. The team at Rheumatology Advisor will be reporting on the latest news and research conducted by leading experts in rheumatology. Check back for more from the 2019 ACR/ARP Annual Meeting.

ATLANTA – Compared with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS) can better assess response to biologic medications among patients with axial spondyloarthritis (axSpA) with coexistent fibromyalgia, according to research results presented at the 2019 American College of Rheumatology/Association of Rheumatology Professionals (ACR/ARP) Annual Meeting, held November 8 to 13, 2019, in Atlanta, Georgia.

The study included data from 85 patients with axSpA (65 men; mean age, 44.7±13.3 years; mean disease duration, 9.5±9.9 years). Researchers collected data on demographic characteristics, extra-articular manifestations, and outcome measures, and patients were categorized as either responders or nonresponders to biologics. For both groups, the researchers determined the mean scores for the individual questions of BASDAI, Bath Ankylosing Spondylitis Functional Index (BASFI), ASDAS, and C-reactive protein (CRP). They performed further analysis after stratifying patients into 3 groups: group 1 (BASDAI ≥4, ASDAS ≥2.1), group 2 (BASDAI <4, ASDAS ≥2.1) and group 3 (BASDAI <4, ASDAS <2.1).

At baseline, mean BASDAI scores were similar between responders and nonresponders receiving biologics (6.1 and 6.2, respectively).

After treatment with biologic medications, patients with clinical nonresponse had higher mean scores for question 1 (fatigue) and question 4 (musculoskeletal areas of tenderness; 7.7 and 6.5, respectively) of the BASDAI compared with responders (3.8 and 2.2, respectively). Compared with responders, nonresponders had a higher mean score for BASFI (2.2 vs 5.9, respectively).

After performing further analysis using ASDAS, the researchers found that group 1 had higher mean scores for question 1 and question 4 (6.9 and 6.0, respectively) of the BASDAI and coexistent fibromyalgia compared with groups 2 (2.6 and 2.6, respectively) and 3 (3.3 and 1.7, respectively). Group 1 also had a higher mean BASFI compared with groups 2 and 3 (5.2 vs 2.4 and 1.6, respectively).

Compared with groups 1 and 3, patients in group 2 had higher mean CRP (3.5 and 3.1 vs 11.4, respectively), denoting a higher inflammatory burden.

“These findings support the hypothesis that fatigue and pain, as reflected by high scores for [question] 1 and [question] 4 of the BASDAI and coexistent fibromyalgia, are possible drivers of high perceived disease activity and nonresponse to biologics,” the researchers concluded. “ASDAS provides a means of incorporating more objective measures of disease activity, such as CRP, into clinical assessment, and therefore, provides a useful adjunct to traditional Bath scores in assessing response to biologics,” they added.

Disclosure: One study author declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of author’s disclosures.

Visit Rheumatology Advisor for live coverage and more news from the 2019 ACR/ARP Annual Meeting.

Reference

Sacks S, Rigler K, Chan A. The Ankylosing Spondylitis Disease Activity Score reflects and predicts response to biologic treatment in axial spondyloarthritis patients with coexistent fibromyalgia compared to the Bath Ankylosing Spondylitis Disease Activity Index. Presented at: 2019 ACR/ARP Annual Meeting; November 8-13, 2019; Atlanta, GA. Abstract 1819.