In a real-world study, 3 of 4 patients with ankylosing spondylitis did not achieve ASDAS low disease activity after 6 months on a bDMARD.1 Many patients settle with continued symptoms despite being on treatment. Clinical assessments, such as ASDAS-CRP LDA, include patient‑reported outcomes that can help identify patients who may need disease control.
Seeing the need
Be aware of potentially suboptimal outcomes, which patients may be unable to communicate.
In a 2021 real-world study of 130 patients with AS, 75% (n=97) did not achieve low disease activity 6 months after bDMARD initiation, as defined by ASDAS <2.1 (one common way to measure disease activity).1
Taking action
What else could you do to regularly assess disease activity and aim for a target?
To achieve the goals of controlling the symptoms of disease and inflammation, preventing progressive structural damage, and maintaining physical function, ASAS-EULAR guidelines recommend setting a predefined treatment target for AS, such as ASDAS LDA or ASDAS ID.2,3
Assess disease activity with ASDAS LDA.
Life with LDA
What could ASDAS low disease activity mean for your patients with AS?
Studies have shown that patients who achieve more stringent outcomes goals, such as ASAS40 and ASDAS LDA, are more likely to experience:
- Improved quality of life and physical function (with achievement of ASAS40)4
- Decreased radiographic spinal progression and improvement in work impairment (with achievement of ASDAS LDA)1,5,6
Do you see both AS and nr‑axSpA patients?
AS=ankylosing spondylitis; ASAS=Assessment of SpondyloArthritis international Society; ASDAS=Ankylosing Spondylitis Disease Activity Score; bDMARD=biological disease-modifying antirheumatic drug; CRP=C-reactive protein; EULAR=European Alliance of Associations for Rheumatology; ID=inactive disease; LDA=low disease activity; nr‑axSpA=non-radiographic axial spondyloarthritis; RA=rheumatoid arthritis.
References: 1. Mease P, McLean R, Blachley T, et al. Impact of achieving ASDAS LDA on disease activity and patient-reported outcome measures among patients with ankylosing spondylitis treated with biologic DMARDs. Abstract presented at: ACR Convergence; November 5-9, 2021. 2. Ramiro S, Nikiphorou E, Sepriano A, et al. ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update. Ann Rheum Dis. 2023;82:19-34. doi:10.1136/ard-2022-223296 3. Smolen JS, Schöls M, Braun J, et al. Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force [published correction appears in Ann Rheum Dis. 2018;77(3):472]. Ann Rheum Dis. 2018;77(1):3-17. doi:10.1136/annrheumdis-2017-211734 4. Mease P, Walsh JA, Baraliakos X, et al. Translating improvements with ixekizumab in clinical trial outcomes into clinical practice: ASAS40, pain, fatigue, and sleep in ankylosing spondylitis. Rheumatol Ther. 2019;6(3):435-450. doi:10.1007/s40744-019-0165-3 5. Machado P, Landewé R, Lie E, 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. doi:10.1136/ard.2010.138594 6. Ramiro S, van der Heijde D, van Tubergen A, et al. Higher disease activity leads to more structural damage in the spine in ankylosing spondylitis: 12-year longitudinal data from the OASIS cohort. Ann Rheum Dis. 2014;73(8):1455-1461. doi:10.1136/annrheumdis-2014-205178