AB0717 THE ASAS-HEALTH INDEX MAY BE USEFUL TO IDENTIFY DISEASE ACTIVITY STATES IN PATIENTS WITH SPONDYLOARTHRITIS.
Authors: S. Alonso Castro, E. Pardo Campo, L. C. Charca Benavente, M. Pino Martínez, S. Fernández, L. M. Arboleya Rodríguez, M. Alperi-López, R. Queiró Silva
Journal: Annals of the Rheumatic Diseases (2020)

Background: Patients with spondyloarthritis (SpA) suffer not only from pain or physical disability, but they are also affected in multiple facets of life due to this condition (disease impact). Recently, the ASAS group has proposed a new way of capturing the impact that SpA have on patients’ lives, based on the principles proposed by the International classification of functioning, disability and health (ICF). The tool obtained (ASAS-health index or ASAS-HI) includes 17 items that cover most ICF domains. Objectives: To analyze the performance of ASAS-HI in real clinical practice, by comparing it with other standard measures of evaluation of SpA. To assess whether ASAS-HI is able to identify disease activity states in these patients. Methods: This cross-sectional study included 111 consecutive patients with SpA (ASAS criteria). The correlation (Spearman’s rho) between ASAS-HI, BASDAI, ASDAS, and BASFI was analyzed. ROC curves were constructed to analyze ASAS-HI values that determined BASDAI remission, ASDAS inactive disease, and ASDAS low activity. A logistic regression was made to determine the ASAS-HI items with greater capability to discriminate the state of remission / inactive disease. Results: Seventy-four men and 37 women were included, mean age of 43.3 ± 10.6 years. The average duration of illness was 7.6 ± 6.8 years. Sixty percent of the series was under biological therapy. HLA-B27 was positive in 79.3%. The average value of ASAS-HI was 5.4 ± 3.8. There were significant correlations between ASDAS and BASDAI (rho: 0.89, p &lt;0.0005), BASDAI and BASFI (rho: 0.86, p &lt;0.0005), BASFI and ASDAS (rho: 0.78, p &lt;0.0005), BASDAI and ASAS-HI (rho: 0.77, p &lt;0.0005), ASDAS and ASAS-HI (rho: 0.70, p &lt;0.0005). The optimal cut-off point of ASAS-HI for BASDAI remission (Table 1) corresponded to a value ≤ 2. As for the value of ASAS-HI to define ASDAS inactive disease (Table 2), this was ≤ 0. For ASDAS low activity, the value was ≤ 6 [area under the ROC curve 0.82 (95% CI: 0.73-0.89), Sen: 89.5%, Spe: 66.1). In the multivariate regression, the two ASAS-HI items associated with BASDAI non-remission were, “I often get frustrated” [OR 9.2 (95% CI: 1.2-69.4), p = 0.032], and “I sleep badly at night” [OR 7.7 (95% CI: 1.4-41.6), p = 0.018). As for ASDAS, the only question of ASAS-HI significantly associated with active disease was “pain sometimes disrupts my normal activities” [OR 8.7 (95% CI: 1.7-45.2), p = 0.010]. Conclusion: ASAS-HI correlates well with most outcome measures in SpA. A cut-off point of ASAS-HI ≤ 6 identifies a low disease activity and could be considered a good treatment objective. The evaluation of SpA should include not only conventional measures (BASDAI / ASDAS) but also disease impact measures (ASAS-HI). Table 1. Area under the ROC curve (AUC) 0.883 95% CI 0.809-0.936 p-value &lt;0.0001 Optimal cut-off point ≤2 Sensitivity 65.71 Specificity 96.05 Table 2. Area under the ROC curve (AUC) 0.873 95% CI 0.797-0.929 p-value &lt;0.0001 Optimal cut-off point ≤0 Sensitivity 58.82 Specificity 94.68 Disclosure of Interests: None declared