The BASDAI Cut-Off for Disease Activity Corresponding to the ASDAS Scores in a Taiwanese Cohort of Ankylosing Spondylitis

Yi-Hsing Chen; Wen-Nan Huang; Yi-Ming Chen; Kuo-Lung Lai; Tsu-Yi Hsieh; Wei-Ting Hung; Ching-Tsai Lin; Chih-Wei Tseng; Kuo-Tung Tang; Yin-Yi Chou; Yi-Da Wu; Chin-Yin Huang; Chia-Wei Hsieh; Yen-Ju Chen; Yu-Wan Liao; Hsin-Hua Chen

doi:10.3389/fmed.2022.856654

The BASDAI Cut-Off for Disease Activity Corresponding to the ASDAS Scores in a Taiwanese Cohort of Ankylosing Spondylitis

Front Med (Lausanne). 2022 May 16:9:856654. doi: 10.3389/fmed.2022.856654. eCollection 2022.

Authors

Yi-Hsing Chen^{1

2

3}, Wen-Nan Huang^{2

3

4}, Yi-Ming Chen^{1

2

3

5}, Kuo-Lung Lai^{1

3}, Tsu-Yi Hsieh^{1

3

6

7}, Wei-Ting Hung^{1

3

6}, Ching-Tsai Lin^{1

3}, Chih-Wei Tseng^{1

3}, Kuo-Tung Tang^{1

2

3}, Yin-Yi Chou^{1

8}, Yi-Da Wu^{1

3}, Chin-Yin Huang⁸, Chia-Wei Hsieh^{1

2

3}, Yen-Ju Chen^{1

2

5}, Yu-Wan Liao^{1

3}, Hsin-Hua Chen^{1

2

3

8

9

10

11}

Affiliations

¹ Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
² School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
³ Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
⁴ Department of Business Administration, Ling-Tung University, Taichung, Taiwan.
⁵ Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.
⁶ Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan.
⁷ PhD Program of Business, College of Business, Feng Chia University, Taichung, Taiwan.
⁸ Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan.
⁹ Division of General Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
¹⁰ Institute of Biomedical Science and Rong-Hsing Research Center for Translational Medicine, Chung-Hsing University, Taichung, Taiwan.
¹¹ Institute of Public Health and Community Medicine Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.

Abstract

Objectives: The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) has been widely utilized to evaluate disease activity in patients with ankylosing spondylitis (AS) by an arbitrary cut-off of ≥4 to indicate high disease activity and initiate biological therapy. The Ankylosing Spondylitis Disease Activity Score (ASDAS) is a new composite index to assess AS disease activity states that have been defined and validated. ASDAS ≥2.1 was selected as a criterion to start biological therapy. The purpose of this study was to estimate the corresponding BASDAI and ASDAS cut-off in a Taiwanese AS cohort.

Methods: From November 2016 to October 2018, we assessed the ASDAS and the BASDAI regularly and recorded demographic data for 489 AS patients in Taichung Veterans General hospital (TCVGH) using an electronic patient-reported data system linked to electronic medical records. We used receiver operating characteristic curves with Youden's J statistic to determine the BASDAI values that correspond to ASDAS disease activity cut-offs (i.e., 1.3, 2.1, and 3.5).

Results: In our population, the best trade-off BASDAI values corresponding to ASDAS -C-reactive protein (CRP) 1.3, 2.1, and 3.5 were 2.1, 3.1, and 3.7, respectively. The optimal BASDAI values corresponding to ASDAS-erythrocyte sedimentation rates 1.3, 2.1, and 3.5 were 2.0, 2.6, and 4.8, respectively.

Conclusion: We propose a revised BASDAI cut-off based on our data, as BASDAI scores are commonly used globally. A more reasonable, lower BASDAI cut-off to initiate or change biological therapy will bring us closer to better decisions to treat AS patients.

Keywords: ASDAS; BASDAI score; ankylosing spondylitis; biological therapy; electronic medical records; patient-reported outcome measures.