Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands.
Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
Scand J Rheumatol. 2024 May;53(3):180-187. doi: 10.1080/03009742.2023.2213509. Epub 2023 Jun 20.
In axial spondyloarthritis (axSpA), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS) are recommended for use in treat-to-target (T2T) strategies. However, BASDAI disease states may be a less suitable T2T instrument than ASDAS, since BASDAI contains non-disease activity related items. The objective of our study was to investigate the construct validity of BASDAI and ASDAS disease states.
We performed a single-centre cross-sectional study on BASDAI and ASDAS construct validity in long-term BASDAI T2T-treated axSpA patients. Our hypothesis was that BASDAI is less representative of disease activity than ASDAS owing to the focus on pain and fatigue, and missing an objective item, e.g. C-reactive protein (CRP). This was operationalized using several subhypotheses.
The study included 242 axSpA patients. BASDAI and ASDAS disease states showed a similar relation to Patient Acceptable Symptom State and T2T protocol adherence. The proportions of patients with high BASDAI and ASDAS disease activity fulfilling Central Sensitization Inventory and fibromyalgia syndrome criteria were similar. The correlation with fatigue was moderate for both BASDAI (Spearman's rho 0.64) and ASDAS (Spearman's rho 0.54) disease states. A high ASDAS was strongly correlated with increased CRP (relative risk 6.02, 95% CI 3.0-12.09), while this correlation was not seen for BASDAI (relative risk 1.13, 95% CI 0.74-1.74).
Our study showed moderate and comparable construct validity for BASDAI- and ASDAS-based disease activity states, with the expected exception of association with CRP. Therefore, no strong preference can be given for either measure, although the ASDAS seems marginally more valid.
在中轴型脊柱关节炎（axSpA）中，Bath 强直性脊柱炎疾病活动指数（BASDAI）和强直性脊柱炎疾病活动评分（ASDAS）被推荐用于达标治疗（T2T）策略。然而，BASDAI 疾病状态可能不如 ASDAS 适合作为 T2T 工具，因为 BASDAI 包含与疾病活动无关的项目。我们研究的目的是研究 BASDAI 和 ASDAS 疾病状态的结构效度。
我们对长期接受 BASDAI T2T 治疗的 axSpA 患者进行了一项关于 BASDAI 和 ASDAS 结构效度的单中心横断面研究。我们的假设是，由于 BASDAI 侧重于疼痛和疲劳，并且缺少客观项目（例如 C 反应蛋白（CRP）），因此它不如 ASDAS 能代表疾病活动。这通过几个子假设来实现。
该研究纳入了 242 例 axSpA 患者。BASDAI 和 ASDAS 疾病状态与患者可接受的症状状态和 T2T 方案依从性具有相似的关系。满足中枢敏化量表和纤维肌痛综合征标准的高 BASDAI 和 ASDAS 疾病活动患者的比例相似。BASDAI（Spearman's rho 0.64）和 ASDAS（Spearman's rho 0.54）疾病状态与疲劳的相关性均为中度。高 ASDAS 与 CRP 升高强烈相关（相对风险 6.02，95%CI 3.0-12.09），而 BASDAI 则没有这种相关性（相对风险 1.13，95%CI 0.74-1.74）。
我们的研究表明，基于 BASDAI 和 ASDAS 的疾病活动状态具有中等且相当的结构效度，除了与 CRP 的关联外。因此，不能强烈偏爱任何一种测量方法，尽管 ASDAS 似乎稍微更有效。
