Monitoring axSpA Disease Activity in Clinical Practice

Validated disease activity measures, both generic and specific for axial spondyloarthritis (axSpA), are widely available, but “there is vast scope to improve their actual utilization in routine clinical practice,” wrote the authors of a review published in Current Rheumatology Reports.

The researchers describe results from a survey conducted among general rheumatologists as well as Spondyloarthritis Research and Treatment Network (SPARTAN) members about how they use disease activity measurement in daily practice.

In the 2019 American College of Rheumatology (ACR)/Spondylitis Association of America (SAA)/Spondyloarthritis Research and Treatment Network (SPARTAN) axSpA treatment guidelines, validated measures such as Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) or Ankylosing Spondylitis Disease Severity Index (ASDAS) are conditionally recommended for regular monitoring of disease activity. ASDAS is recommended by the Assessment of Spondyloarthritis International Society (ASAS)-European Alliance of Associations for Rheumatology (EULAR) guidelines “as the most appropriate instrument for the assessment of disease activity, preferably calculated using C-reactive protein (CRP),” the authors noted.

ASAS recently updated its core set of variables, which are endorsed by the Outcome Measures in Rheumatology Clinical Trials (OMERACT) group, to provide homogeneity in assessment of axSpA. In addition, Patient-Reported Outcomes Measurement Information System (PROMIS) measures have demonstrated the ability to distinguish inactive, moderate, and high–very high ASDAS activity groups. “A newly developed semi-objective index P4 (pain, physical function, patient global, and physician global) correlates well with BASDAI and ASDAS in axSpA and can also be used for other rheumatic diseases in busy clinical practices,” the investigators wrote.

The authors further pointed out, “The integration of electronic health records and smart devices provides a great opportunity to capture patient-reported data. Automated capture of electronic patient-reported outcome measures (ePROMs) is highly efficient and results in consistent regular monitoring and may improve the long-term outcomes. While currently used measures focus only on musculoskeletal symptoms of axSpA, a composite disease activity measure that can also incorporate extra-articular manifestations may provide a better assessment of disease activity.”

Reference:

Kumthekar, A., Sanghavi, N., Natu, A. et al. How to monitor disease activity of axial spondyloarthritis in clinical practice. Curr Rheumatol Rep 2024;26(2):170–177 https://doi.org/10.1007/s11926-024-01141-0