Information on this page applies to patients with AS or nr‑axSpA.
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
About 20–30% of spondyloarthritis (SpA) patients discontinue a TNF inhibitor treatment because they fail to respond or their response is inadequate, and 10–20% stop because of a lack or loss of efficacy or the onset of adverse events, in a review of the literature from 1999 to 2016.2
One survey of 592 patients with rheumatic diseases, including AS, indicated that up to 50% were seldom or never queried about the impact of their disease on their quality of life, and that normalization of quality of life and symptom relief were the most important treatment attributes for these patients.3
Taking action
What else could you do to regularly assess disease activity and aim for a target?
- It’s important to consider all aspects of disease activity when managing patients with AS or nr‑axSpA—from specific measures of individual clinical manifestations to assessing the impact on a patient’s quality of life.4,5
- ASAS-EULAR guidelines recommend setting treatment goals to achieve improvement in ASDAS, with individualized monitoring and assessment for optimal patient outcomes in AS and nr‑axSpA.6
- The ASAS International Working Group recommended the following: disease activity of patients with AS and nr‑axSpA was monitored under the supervision of a rheumatologist with validated composite scores at least every 6 months.6,7
Assess disease activity with ASDAS LDA.
Life with LDA
What could ASDAS low disease activity mean for your patients?
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)8
- Decreased radiographic spinal progression and improvement in work impairment (with achievement of ASDAS LDA)1,9,10
Patients achieving ASDAS LDA had greater improvement in overall work impairment (17.7% vs 5.9%), resulting in a $6,152 greater annual reduction in lost wages relative to those who did not achieve ASDAS LDA.1
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; LDA=low disease activity; nr‑axSpA=non-radiographic axial spondyloarthritis; RA=rheumatoid arthritis; TNFi=tumor necrosis factor inhibitor.
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. Benucci M, Damiani A, Bandinelli F, et al. Ankylosing spondylitis treatment after first anti-TNF drug failure. Isr Med Assoc J. 2018;20(2):119-122. 3. Rosenbaum JT, Pisenti L, Park Y, Howard RA. Insight into the quality of life of patients with ankylosing spondylitis: real-world data from a US-based life impact survey. Rheumatol Ther. 2019;6(3):353-367. doi:10.1007/s40744-019-0160-8 4. Redeker I, Callhoff J, Hoffmann F, et al. The prevalence and impact of comorbidities on patients with axial spondyloarthritis: results from a nationwide population-based study. Arthritis Res Ther. 2020;22(1):210. doi:10.1186/s13075-020-02301-0 5. Strand V, Singh JA. Patient burden of axial spondyloarthritis. J Clin Rheumatol. 2017;23(7):383-391. doi:10.1097/RHU.0000000000000589 6. Ramiro S, Nikiphorou E, Sepriano A, et al. ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update. Ann Rheum Dis. 2023;82(1):19-34. doi:10.1136/ard-2022-223296 7. Spoorenberg A, van Tubergen A, Landewé R, et al. Measuring disease activity in ankylosing spondylitis: patient and physician have different perspectives. Rheumatology (Oxford). 2005;44(6):789-795. doi:10.1093/rheumatology/keh595 8. 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 9. 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 10. 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