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

See more in PubMed

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. Ann Rheum Dis. 2018;77:3–17. doi: 10.1136/annrheumdis-2017-211734. PubMed DOI PMC

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. PubMed DOI

Lukas C, Landewé R, Sieper J, et al. Development of an ASAS-endorsed disease activity score (ASDAS) in patients with ankylosing spondylitis. Ann Rheum Dis. 2009;68:18–24. doi: 10.1136/ard.2008.094870. PubMed DOI

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;70:47–53. doi: 10.1136/ard.2010.138594. PubMed DOI

Machado P, Landewé RBM, van der Heijde DM, et al. Endorsement of definitions of disease activity states and improvement scores for the Ankylosing Spondylitis Disease Activity Score: results from OMERACT 10. J Rheumatol. 2011;38:1502–6. doi: 10.3899/jrheum.110279. PubMed DOI

Michelsen B, Lindström U, Codreanu C, et al. Drug retention, inactive disease and response rates in 1860 patients with axial spondyloarthritis initiating secukinumab treatment: routine care data from 13 registries in the EuroSpA collaboration. RMD Open. 2020;6:e001280. doi: 10.1136/rmdopen-2020-001280. PubMed DOI PMC

Ørnbjerg LM, Brahe CH, Askling J, et al. Treatment response and drug retention rates in 24 195 biologic-naïve patients with axial spondyloarthritis initiating TNFi treatment: routine care data from 12 registries in the EuroSpA collaboration. Ann Rheum Dis. 2019;78:1536–44. doi: 10.1136/annrheumdis-2019-215427. PubMed DOI

van der Heijde D, Deodhar A, Braun J, et al. The effect of golimumab therapy on disease activity and health-related quality of life in patients with ankylosing spondylitis: 2-year results of the GO-RAISE trial. J Rheumatol. 2014;41:1095–103. doi: 10.3899/jrheum.131003. PubMed DOI

Dougados M, Wei JC-C, Landewé R, et al. Efficacy and safety of ixekizumab through 52 weeks in two phase 3, randomised, controlled clinical trials in patients with active radiographic axial spondyloarthritis (COAST-V and COAST-W) Ann Rheum Dis. 2020;79:176–85. doi: 10.1136/annrheumdis-2019-216118. PubMed DOI PMC

Molto A, López-Medina C, Van den Bosch FE, et al. Efficacy of a tight-control and treat-to-target strategy in axial spondyloarthritis: results of the open-label, pragmatic, cluster-randomised TICOSPA trial. Ann Rheum Dis. 2021;80:1436–44. doi: 10.1136/annrheumdis-2020-219585. PubMed DOI PMC

Doganay Erdogan B, Leung YY, Pohl C, et al. Minimal Clinically Important Difference as Applied in Rheumatology: An OMERACT Rasch Working Group Systematic Review and Critique. J Rheumatol. 2016;43:194–202. doi: 10.3899/jrheum.141150. PubMed DOI

Pope JE, Khanna D, Norrie D, et al. The minimally important difference for the health assessment questionnaire in rheumatoid arthritis clinical practice is smaller than in randomized controlled trials. J Rheumatol. 2009;36:254–9. doi: 10.3899/jrheum.080479. PubMed DOI

Ying Leung Y, Yves Zufferey P, Cantonal Hospital F, et al. The BASDAI Cut-Off for Disease Activity Corresponding to the ASDAS Scores in a Taiwanese Cohort of Ankylosing Spondylitis. Front Med (Lausanne) 2022;1:856654. doi: 10.3389/fmed.2022.856654. PubMed DOI PMC

Kwon OC, Park M-C. BASDAI cut-off values corresponding to ASDAS cut-off values. Rheumatol (Oxford) 2022;61:2369–74. doi: 10.1093/rheumatology/keab494. PubMed DOI

Kilic G, Kilic E, Ozgocmen S. Is there any gender-specific difference in the cut-off values of ankylosing spondylitis disease activity score in patients with axial spondyloarthritis? Int J Rheum Dis. 2017;20:1201–11. doi: 10.1111/1756-185X.12885. PubMed DOI

Perkins NJ, Schisterman EF. The Inconsistency of “Optimal” Cutpoints Obtained using Two Criteria based on the Receiver Operating Characteristic Curve. Am J Epidemiol. 2006;163:670–5. doi: 10.1093/aje/kwj063. PubMed DOI PMC

Ørnbjerg LM, Rugbjerg K, Georgiadis S, et al. One-Third of European Patients With Axial Spondyloarthritis Reach Pain Remission With Routine Care Tumor Necrosis Factor Inhibitor Treatment. J Rheumatol. 2023;50:1009–19. doi: 10.3899/jrheum.220459. PubMed DOI

Kilic E, Kilic G, Akgul O, et al. Discriminant validity of the Ankylosing Spondylitis Disease Activity Score (ASDAS) in patients with non-radiographic axial spondyloarthritis and ankylosing spondylitis: a cohort study. Rheumatol Int. 2015;35:981–9. doi: 10.1007/s00296-014-3168-y. PubMed DOI

van der Horst-Bruinsma IE, Zack DJ, Szumski A, et al. Female patients with ankylosing spondylitis: analysis of the impact of gender across treatment studies. Ann Rheum Dis. 2013;72:1221–4. doi: 10.1136/annrheumdis-2012-202431. PubMed DOI

Lubrano E, Perrotta FM, Manara M, et al. The Sex Influence on Response to Tumor Necrosis Factor-α Inhibitors and Remission in Axial Spondyloarthritis. J Rheumatol. 2018;45:195–201. doi: 10.3899/jrheum.17666. PubMed DOI

Kristensen LE, Karlsson JA, Englund M, et al. Presence of peripheral arthritis and male sex predicting continuation of anti–tumor necrosis factor therapy in ankylosing spondylitis: An observational prospective cohort study from the South Swedish arthritis treatment group register. Arthritis Care Res (Hoboken) 2010;62:1362–9. doi: 10.1002/acr.20258. PubMed DOI

Hebeisen M, Neuenschwander R, Scherer A, et al. Response to Tumor Necrosis Factor Inhibition in Male and Female Patients with Ankylosing Spondylitis: Data from a Swiss Cohort. J Rheumatol. 2018;45:506–12. doi: 10.3899/jrheum.170166. PubMed DOI

Ørnbjerg LM, Linde L, Georgiadis S, et al. Predictors of ASDAS-CRP inactive disease in axial spondyloarthritis during treatment with TNF-inhibitors: Data from the EuroSpA collaboration. Semin Arthritis Rheum. 2022;56:152081. doi: 10.1016/j.semarthrit.2022.152081. PubMed DOI

Pinto AS, Farisogullari B, Machado PM. Predictors of remission in people with axial spondyloarthritis: A systematic literature review. Semin Arthritis Rheum. 2022;56:152078. doi: 10.1016/j.semarthrit.2022.152078. PubMed DOI

Ciurea A, Scherer A, Weber U, et al. Age at symptom onset in ankylosing spondylitis: is there a gender difference? Ann Rheum Dis . 2014;73:1908–10. doi: 10.1136/annrheumdis-2014-205613. PubMed DOI

Linde L, Ørnbjerg LM, Rasmussen SH, et al. Commonalities and differences in set-up and data collection across European spondyloarthritis registries - results from the EuroSpA collaboration. Arthritis Res Ther. 2023;25:205. doi: 10.1186/s13075-023-03184-7. PubMed DOI PMC

Midtbøll Ørnbjerg L, Georgiadis S, Kvien TK, et al. POS0410 IMPACT of sex, age and disease duration on asdas cut-offs for disease activity states in axial spondyloarthritis - results from the eurospa collaboration. Ann Rheum Dis. 2024:483–4. doi: 10.1136/annrheumdis-2024-eular.1775. DOI