Notes
Slide Show
Outline
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Defining the Active Patient
AS Measurement Tools
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Standardized Questionnaires and Scales
  • Used in clinical trials
  • Might be used in clinical practice
  • May aid physician to identify those with active disease
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AS Measures of Disease Outcome
  • Bath Ankylosing Spondylitis (BAS) scales
    • BASDAI – Disease Activity Index
    • BASFI – Functional Index
    • BASGI – Global Index
    • BASMI – Metrology Index
    • BASRI – Radiographic Index
  • Other measurement indexes
    • SF-36 – 36-Item Medical Outcomes Study Short-Form Health Survey
    • ASAS – Assessments in Ankylosing Spondylitis Working Group Improvement Criteria
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Disease Activity Assessment
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Bath Ankylosing Spondylitis Functional Index (BASFI)
  • Self-administered questionaire
  • Mean (VAS) of 10 questions:


    • 8 of which relate to the functional anatomy of subjects


    • 2 relate to a subject’s ability to cope with everyday life
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Bath Ankylosing Spondylitis Functional Index (BASFI)
  • 1.) Putting on your socks or tights without help or aids (e.g sock aid).
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Bath Ankylosing Spondylitis Functional Index (BASFI)
  • 6.) Standing unsupported for ten minutes without discomfort?
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Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)
  • The following VAS (0 to 10 cm) of subject self-assessments:
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Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)
  • 1.) How would you describe the overall level of fatigue/tiredness you have experienced?
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Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)
  • 4.) How would you describe the overall level of discomfort you have had from any areas tender to touch or pressure?
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Bath Ankylosing Spondylitis Metrology Index (BASMI)
  • Represented as aggregate score (ranging from 0 to 10) using the variables found in the following table
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ASAS Response Criteria
  • ASAS Response Criteria
    • Patients will be categorized as an ASAS 20 responder if the patient achieves the following:
      • > 20% improvement from baseline and absolute baseline improvement of > 10 (on a 0-100mm scale) in at least 3 of the following 4 domains:
        • Patient global
        • Spinal pain
        • Function (BASFI)
        • Inflammation
      • No deterioration from the baseline (> 20% and absolute change of at least 10 on a 0 to 100 mm scale) in the potential remaining domain
  • ASAS Major Clinical Response
    • Requires a value below 20 (scale of 0 to 100 mm) in each of the 4 ASAS domains
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ASAS Working Group Definition of
Partial Remission
  • Patients will be categorized as in ASAS partial remission if the patient achieves the following:
    Value < 20 (0-100 scale) in all 4 domains of ASAS Working Group Criteria for Improvement
        • Patient global
        • Spinal pain
        • Function (BASFI)
        • Inflammation
          • average of the last 2 BASDAI questions concerning level and duration of morning stiffness
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Which Patients Should Be Treated
With Anti-TNF Therapy in Daily Practise?

ASAS-Consensus Statement (Berlin, Jan 2003)*
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When Should Treatment
With TNF Blockers Be Discontinued?