OBJECTIVES: To re-evaluate cut-offs for disease activity states according to the Axial Spondyloarthritis Disease Activity Score (ASDAS), and study the impact of sex, age, calendar time, disease and symptom duration on ASDAS and ASDAS cut-offs in a large contemporary cohort. METHODS: Data from 2939 patients with axial spondyloarthritis (axSpA) starting their first tumour necrosis factor inhibitor in nine European registries were pooled and analysed. Receiver operating characteristic analyses were performed to identify cut-offs against external criteria. Six-month data including patient and physician global assessments, both ≤1 (0-10 integer scale), and Assessment of SpondyloArthritis International Society partial remission were used for separation of inactive disease (ID) from low disease activity (LDA), while patient and physician global ≤3 were applied as external criteria to separate LDA from high disease activity (HDA). Patient and physician global ≥6 were applied to separate HDA from very high disease activity in baseline data. RESULTS: The three ASDAS cut-offs identified to separate the four disease activity states in the overall patient population were <1.3, <2.0 and >3.5. Cut-offs for ID and LDA in women were higher (<1.5 and <2.0, respectively) than in men (<1.3 and <1.9), as were cut-offs in patients ≥45 years (<1.5 and <2.2) versus ≤34 years (<1.2 and <1.9) and 35-44 years (<1.3 and <1.8). Cut-offs were independent of calendar time and disease duration. CONCLUSIONS: Re-evaluation of ASDAS cut-offs for disease activity states in a large multi-national axSpA cohort resulted in cut-offs similar to those currently endorsed. Differences in cut-offs between sex and age groups for ID and LDA were observed, but the differences were minor.

Center for Treatment of Rheumatic and Musculoskeletal Diseases Diakonhjemmet Hospital Oslo Norway

Centre for Rheumatology Research Landspitali University Hospital Reykjavik Iceland

Copenhagen Center for Arthritis Research Center for Rheumatology and Spine Diseases Rigshospitalet Copenhagen Denmark

Department of Clinical Medicine Aarhus University Aarhus Denmark

Department of Clinical Medicine University of Copenhagen Copenhagen Denmark

Department of Clinical Sciences Lund Rheumatology Skåne University Hospital Lund University Lund Sweden

Department of Internal Medicine Division of Rheumatology Dokuz Eylul University School of Medicine Izmir Turkey

Department of Rheumatology 1st Faculty of Medicine Charles University Prague Czech Republic

Department of Rheumatology Aarhus University Hospital Aarhus Denmark

Department of Rheumatology Hospital Garcia de Orta Almada Portugal

Department of Rheumatology University Hospital of Geneva Geneva Switzerland

Department of Rheumatology University Hospital Zurich University of Zurich Zurich Switzerland

Department of Rheumatology University Medical Centre Ljubljana Ljubljana Slovenia

Departments of Medicine and Rheumatology Helsinki University Hospital Helsinki Finland

Division of Clinical Epidemiology Department of Medicin Solna Karolinska Institutet Stockholm Sweden

EpiDoC unit CEDOC Nova Medical School Lisbon Portugal

Faculty of Medicine University of Iceland Reykjavik Iceland

Faculty of Medicine University of Ljubljana Ljubljana Slovenia

Faculty of Medicine University of Oslo Oslo Norway

Institute of Rheumatology Prague Czech Republic

Instituto Medicina Molecular Faculdade de Medicina da Universidade de Lisboa Centro Académico de Medicina de Lisboa Lisbon Portugal

Izmir Katip Celebi University School of Medicine Department of Internal Medicine Division of Rheumatology Izmir Ataturk Education and Research Hospital Izmir Turkey

Research Unit Sørlandet Hospital Kristiansand Norway

Reuma pt Sociedade Portuguesa de Reumatologia Lisbon Portugal

Rheumatology Unit Hospital dos Lusíadas Lisbon Portugal

The DANBIO registry Copenhagen Denmark

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