Background/Purpose: The ASAS Health Index (ASAS HI) have been developed to measure health and impairment in functioning in patients with spondyloarthritis (SpA). Its measurement properties have already been evaluated in a cohort study. So far, its association with structural damage has not been examined. The purpose is to investigate the relationship between clincial data, function and health as assessed by the ASAS HI and to investigate the influence of structural spinal damage in patients with axial SpA (axSpA) on the ASAS HI.

Methods: Patients fullfilling ASAS classification criteria for axial SpA (axSpA) were recruited prospectively. Information was collected on clinical assessments (ASAS HI, NRS pain, BASDAI, ASDAS, BASFI, BASMI), laboratory parameters and spinal x-rays. Imaging were scored using mSASSS by two independent readers. The relationship between ASAS HI and other health outcomes was evaluated by Spearman correlation.

Results: A total of 150 patients (57 nr-axSpA and 93 AS patients) were included: 68.7% male, mean (SD) age 46.4 (14.1), symptom duration 18.7 (13.5) and diagnosis since 11.4 (11.8) years, and HLA-B27 positive in 82.0%. Values of clinical assessments were ASAS HI 7.4 (4.1), BASDAI 4.7 (2.3), ASDAS 2.7 (1.1), BASMI 3.3 (1.8), pain 5.7 (2.7), and BASFI 4.7 (2.6). An elevated CRP level was found in 34.8% of the patients. Radiographs of the sacroiliac (SI) joint and the spine were available in 138 patients, 38.0% of which had syndesmophytes and 7.5% a bamboo spine. The median (IQR) mSASSS value was 4.3 (IQR 1.0-22.1) in AS und 0.2 (IQR 0.0-1.4) in nr-axSpA patients. Patients received a treatment with NSAIDs (62.7%), DMARDs (20.9%) and/or biologics (49.4%). Significant correlation of ASAS HI was noted for BASMI (0.5), BASDAI (0.7), ASDAS (0.5) and BASFI (0.8).No correlations were found for ASAS HI and any of the results for radiographic damage (mSASSS 0.2, syndesmophytes 0.01, bamboo spine 0.2) and CRP level (0.07). Startifying patient population by symptom duration (cut-off 3 years) does not change the results.

Conclusion: Measures of function and spinal mobility correlate well with the ASAS HI in patients with SpA. Probably due to relatively low mSASSS scores at baseline, the influence of structural changes as measured by mSASSS on the ASAS HI was rather limited in this study. Further study in more severely affected patients is needed to study the association of physical activity, spinal mobility, function and radiographic damage.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/real-life-performance-of-the-asas-health-index-in-routine-care-of-patients-with-spondyloarthritis/