Defining disease status in ankylosing spondylitis: validation and cross-cultural adaptation of the Arabic Bath Ankylosing Spondylitis Functional Index (BASFI), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and the Bath Ankylosing Spondylitis Global score (BASG)

The Bath Ankylosing Spondylitis Functional Index (BASFI), disease activity index (BASDAI), and Global assessment (BASG) are the most commonly used instruments to assess patients suffering from ankylosing spondylitis (AS). The aim of this study was to translate, adapt, and validate these instruments into the Arabic language. Seventy-three AS patients were included in this study. One question in the BASFI questionnaire was changed to suit the Arabic culture. Also, the VAS in the questionnaires was transformed to numerical rating scales from 0 to 10. After modification, translation, and retranslation of the questionnaires, it was administered and tested for internal consistency, reliability, and construct validity. Magnetic resonance imaging (MRI) of the spine and sacroiliac joints was carried out for 69 patients; scores for disease activity and chronicity were also assessed. The adapted and translated questionnaires demonstrated acceptable comprehensibility scores with a mean of 9.3. Intraclass correlation coefficients for reliability and internal consistency was 0.973 for BASG, whereas standardized alpha ranged between 0.807 and 0.976. The modified item 9 in the BASFI demonstrated a good correlate to the principal component (0.883). When validated, all three questionnaires showed a significant correlation with enthesitis, BAS-radiology index, MRI imaging scores for activity and chronicity, C-reactive protein (CRP), and morning stiffness duration. The Arabic version of the BASFI, BASDAI, and BASG, showed adequate reliability and validity in patients with AS. The measurement properties were comparable to versions in other languages indicating that the questionnaires can be used for evaluation of AS Arabic-speaking patients. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Searching for optimal rating scales in the Bath Ankylosing Spondylitis Functional Index (BASFI) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)

The comparison of the performance of the numerical rating scale (NRS) versus visual analog scale (VAS) in the Bath Ankylosing Spondylitis Functional Index (BASFI) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) showed that the 11-point NRS is psychometrically superior to the 10-cm VAS. This finding is in agreement with previous studies and the recommendation by the Assessment of SpondyloArthritis international Society. To illustrate the functioning of the response categories of both BASFI and BASDAI, we analyzed the rating scales (using the Rasch rating scale model) in patients with ankylosing spondylitis. Our results have shown that the 11 categories available in the 0–10 NRS version of both BASFI and BASDAI exceed the number of levels of a construct that participants can discriminate. This indicates the need for improving the metric quality of both rating scales by appropriately reducing the number of categories.     

Translation and validation of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Bath Ankylosing Spondylitis Functional Index (BASFI) for use in Ukraine

The aim of this study was to translate and adapt the original English-language versions of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Bath Ankylosing Spondylitis Functional Index (BASFI) into Ukrainian and validate the instruments by administering them to Ukrainian patients with ankylosing spondylitis (AS). After consensual translation, cultural adaptation, and back-translation into English, the Ukrainian versions of BASDAI and BASFI were transformed into numerical rating scales and tested on 87 Ukrainian AS patients meeting the modified 1984 New York criteria for AS. The Ukrainian versions were easily understood by the patients and displayed high levels of internal consistency and good reliability. The BASDAI (Ukrainian version) showed significant correlation with the duration of morning stiffness and the Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) and weak correlation with CRP. The BASFI (Ukrainian version) showed significant correlations with Schober’s test, occiput-to-wall distance, and chest expansion measure. Both instruments were sensitive to modifications in the treatment regimen. Accordingly, the Ukrainian-language versions of BASDAI and BASFI reported here can be used to monitor the clinical status of Ukrainian patients with AS.     

The Bath Ankylosing Spondylitis Activity and Function Indices (BASDAI and BASFI) and their correlation with main symptoms experienced by patients with spondyloarthritis

With the aim of assessing whether the Bath Ankylosing Spondylitis Activity and Function Indices (BASDAI and BASFI) are reliable measures of disease activity and function in patients with spondyloarthritides (SpAs), 341 patients with SpA (representing ankylosing spondylitis (14.5%), psoriatic arthritis (27.3%), enteropathic arthritis (6.3%), reactive arthritis (4.9%), and undifferentiated arthritis (46.5%) were asked to complete the BASDAI and BASFI. They were asked to report what their main problems associated with the disease were from a list of seven symptoms: fatigue, neck pain, upper back pain, lower back pain, stiffness, joint pain or swelling, and pain with pressure on joints. Correlations between the main symptoms experienced by patients with SpAs and the indices, defined by Spearman’s correlation coefficient, showed that BASDAI best correlated with neck pain [BASDAI 2 and total BASDAI score correlate strongly (p = 0.003 and 0.001, respectively), and BASDAI 1, 4, and 5 correlate moderately (p = 0.03, 0.02, and 0.01, respectively)], followed by stiffness, upper back pain, pain with pressure, lower back pain, fatigue, and joint pain. Stiffness correlated strongly with nine of ten items on BASFI (BASFI 1 showed moderate correlation, p = 0.01), followed by upper back pain (four of ten items correlated strongly, three of ten correlated moderately), neck pain (three of ten tasks correlated strongly and four of ten correlated moderately), lower back pain (one task correlated strongly, five moderately), joint pain and swelling (four tasks correlated moderately), fatigue (three tasks correlated moderately), and pain with pressure (two tasks correlated moderately). BASDAI and BASFI only partly reflect disease activity and patients’ functional capacity in SpAs. An alternate instrument is required to assess SpA disease activity and functional capacity more precisely.     

Psychometric evaluation of the Moroccan version of the Bath Ankylosing Spondylitis Functional Index (BASFI) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) for use in patients with ankylosing spondylitis

The objectives of this study are to translate, adapt in the Moroccan cultural context, and validate in patients with ankylosing spondylitis (AS) the Bath Ankylosing Spondylitis Functional Index (BASFI) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). The cross-cultural adaptation of the BASFI and BASDAI was obtained in accordance with the guidelines for translation of the health status measures. Eighty-five patients with AS were included in the study. The test–retest reliability and the internal consistency were analyzed, and both questionnaires were assessed for external construct validity. Structural validity was analyzed with correlation matrix. Twenty-four-hour test–retest reliability was good: BASFI intraclass correlation coefficient (ICC) = 0.96 (confidence interval (CI) at 95%, 0.93–0.97), BASDAI ICC = 0.93 (CI at 95%, 0.90–0.95). Cronbach’s alpha was 0.90 for the BASFI and 0.86 for BASDAI. The construct validity of the instruments was evaluated. The BASFI showed a strong validity when correlating its results with Schober’s test (r = −0.56), occipital wall distance (r = 0.46), chest expansion (r = −0.46), BASDAI (r = 0.54), Bath Ankylosing Spondylitis Metrology Index (r = 0.70), Bath Ankylosing Spondylitis Global Score (BAS-G; r = 0.58), Bath Ankylosing Spondylitis Radiology Index (r = 0.61), and the radiological changes in sacroiliac joints (r = 0.54). A good correlation was observed between the BASDAI and the spinal pain (r = 0.53), the number of nocturnal awakenings (r = 0.57), the morning stiffness (r = 0.65), the enthesic index (r = 0.47), the BAS-G (r = 0.53), the BASFI (r = 0.54), and the erythrocyte sedimentation rate (r = 0.41; for all p < 0.001). The correlation matrix showed an intermediate correlation between items. The Moroccan version of the BASFI and the BASDAI showed adequate reliability and validity. These instruments can be used in the clinical evaluation of Moroccan and Arabic-speaking patients with AS.     

Evaluation of the Iranian versions of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI) and the Patient Acceptable Symptom State (PASS) in patients with ankylosing spondylitis

The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Bath Ankylosing Spondylitis Functional Index (BASFI) are widely used instruments in assessment of patients suffering from ankylosing spondylitis (AS). The Patient Acceptable Symptom State (PASS) is regarded as a target for patients' well-being. The aim of this study was to translate and adapt BASDAI, BASFI and PASS into the Iranian official language, Farsi, and evaluate their reliability and validity. Ninety patients with AS were included in this study. The questionnaires were translated into Farsi and back translated into English, modified until the final versions were approved with minor adaptations and the VAS was changed to numerical rating scales from 0 to 10. Forty-eight-hour test-retest agreement showed good reliability: interclass correlation coefficient (ICC) for BASDAI was 0.93 (CI at 95%, 0.90-0.95), for BASFI was 0.96 (CI at 95%, 0.94-0.97) and for PASS was 0.87 (CI at 95%, 0.79-0.92). Chronbach's alpha was 0.95, 0.96 and 0.87 for BASDAI, BASFI and PASS, respectively. BASDAI showed a significant correlation with patient global disease activity index, nocturnal back pain, total back pain, number of swollen joints, number of enthesites, morning stiffness, Bath Ankylosing Spondylitis Global Score (BAS-G), BASFI and BASMI. A significant correlation was also found between BASFI and occiput-to-wall distance, mentum-to-sternum distance, chest expansion, finger-to-floor distance, number of swollen joints, number of enthesites, nocturnal back pain, total back pain, BAS-G, BASDAI and BASMI. Patients who answered "no" to PASS (found their condition unsatisfactory) reported significantly increased pain scores, patient global disease activity scores, BAS-G, BASDAI and BASFI scores. The results showed that the Iranian versions of BASDAI, BASFI and PASS are adequately reliable and valid in patients with AS.     

Translation,cross-cultural adaptation,and validation of the Bath Ankylosing Spondylitis Functional Index (BASFI), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Dougados Functional Index (DFI) in a Spanish speaking population with spondyloarthropathies

OBJECTIVES: The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI) and the Dougados Functional Index (DFI) are the most commonly used instruments to measure disease activity and functioning in ankylosing spondylitis (AS). The aim of this study was to translate, adapt and validate these instruments into the Spanish language. METHODS: The BASDAI, BASFI, and DFI questionnaires were translated into Spanish by three independent bilingual physicians who were familiar with the medical aspects of AS and by one professional translator. Two rheumatologists familiar with instrument validation, and who were aware of the purpose of the study, examined semantic, idiomatic and conceptual issues and produced by consensus unified versions of each instrument. English back-translations from the Spanish were done by a professional translator unaware of the original version. Both English versions were compared, and where needed, modifications to the Spanish versions were made. The Spanish versions were administered to 61 ambulatory patients with AS and to 80 patients with undifferentiated spondyloarthropathy for validation purposes. Reliability and responsiveness were measured in 28 patients participating in a physiotherapy program. RESULTS: Reliability showed an acceptable 24-hour test-retest intraclass correlation coefficient (ICC)--BASFI ICC: 0.68, 95% CI: 0.29-0.85; BASDAI ICC: 0.74, 95% CI: 0.52-0.88 and DFI ICC: 0.87, 95% CI: 0.73-0.94. The construct validity of the instruments was evaluated, and BASDAI was correlated with disease activity measured by the total enthesis count (rs: 0.34); general well being in the last week (rs: 0.7); spinal pain (rs: 0.53) and duration of morning stiffness (rs: 0.64). BASFI correlated with Sch?ber's test (rs: -0.4); occipital-wall distance (rs: 0.38) and thoracic expansion (rs: -0.3). DFI correlated with Sch?ber's test (rs: -0.36); occipital-wall distance (rs: 0.29) and chest expansion (rs: -0.3). The correlation among DFI and BASFI was rs: 0.83. All instruments showed clinical responsiveness in the physiotherapy program (baseline and end of program; mean +/- SD): BASDAI: 6.25 +/- 1.97 and 3.07 +/- 2.04 (p = 0.0001); BASFI: 5.68 +/- 2.29 and 2.88 +/- 1.77 (p = 0.0001); DFI: 16 +/- 7.6 and 8.0 +/- 5.5 (p = 0.001) with effect sizes and standardized effect sizes > 1. CONCLUSIONS: The Mexican Spanish versions of the BASDAI, BASFI, and DFI showed adequate reliability, validity and responsiveness to clinical change. These instruments can be used in the clinical evaluation of Spanish-speaking patients with AS.     

Adaption and validation of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) for use in Germany

Zusammenfassung. Zielsetzung: Das Ziel der vorliegenden Arbeit war die Validierung einer deutschen übersetzung des “Bath Ankylosing Spondylitis Disease Activity Index” (BASDAI). Patienten und Methoden: Die Testung der Validit?t der deutschen Version des BASDAI erfolgte mit Daten einer Kohorte von 134 Patienten mit ankylosierender Spondylitis (AS). Hierzu wurde der BASDAI mit arztseitig erfassten Parametern verglichen: globales Urteil zur Krankheitsaktivit?t, C-reaktives Protein (CRP), Blutsenkungsgeschwindigkeit (BSG), Beweglichkeit der Wirbels?ule (BASMI), sowie Gelenkschwellung und Enthesitis (ja/nein). Darüber hinaus erfolgten Gegenüberstellungen mit Selbsteinsch?tzungen der Patienten zu Schmerzen, funktioneller Beeintr?chtigung (BASFI) und Lebensqualit?t (SF-12). Die diskriminative Validit?t wurde durch Vergleiche der BASDAI-Scores von Subgruppen unterschiedlicher Krankheitsschwere geprüft. Die ?nderungssensitivit?t wurde anhand von Verlaufsdaten einer Plazebo-kontrollierten Studie zur Wirksamkeit des Tumornekrosefaktor (TNF) α-Antagonisten Infliximab bei 70 Patienten mit aktiver und schwerer AS untersucht. Ergebnisse: Die deutsche übersetzung des BASDAI erwies sich als gut verst?ndlich. Nach Rückübersetzung entsprach die englische Version dem englischen Original. Es best?tigte sich, dass die 6 Einzelfragen sowohl unterschiedliche Aspekte der Erkrankung abbilden als auch deutliche Zusammenh?nge zwischen den Einzelkomponenten wie St?rke der Morgensteifigkeit und Rückenschmerzen (r = 0,697) oder St?rke und Dauer der Morgensteifigkeit (r = 0,647) aufzeigen k?nnen. Die gute interne Konsistenz der 6 Komponenten (Cronbach's Alpha=0,82) best?tigte die Subsummierung der Komponenten zu einem Gesamtscore “Krankheitsaktivit?t”. Hohe Korrelationen mit dem globalen Arzturteil (r = 0,659), der globalen Einsch?tzung der Schmerzst?rke durch den Patienten (r = 0,789), mit funktioneller Beeintr?chtigung (BASFI; r = 0,752) und ein signifikanter Zusammenhang zu der H?he des CRP und der BSG unterstreichen, dass der BASDAI Krankheitsaktivit?t misst. Im Vergleich von Patientensubgruppen unterschiedlicher Krankheitsschwere und Krankheitsmanifestationen zeigte der BASDAI gute diskriminative F?higkeiten. In einer Therapiestudie bildete er die gute Wirksamkeit von Infliximab überzeugend ab (Effektst?rke 1,18). Schlussfolgerung: Mit der deutsche übersetzung des BASDAI steht ein gut verst?ndliches, einfach anzuwendendes, zuverl?ssiges und ?nderungssensitives Instrument zur Erfassung der Krankheitsaktivit?t bei ankylosierender Spondylitis zur Verfügung. Correspondence to: Dr. J. Brandt     

Spondyloarthritis in women: differences in disease onset,clinical presentation,and Bath Ankylosing Spondylitis Disease Activity and Functional indices (BASDAI and BASFI) between men and women with spondyloarthritides

The aim of this study is to assess the gender differences in spondyloarthritides (SpAs) in terms of disease onset, clinical presentation, and the Bath Ankylosing Spondylitis Disease Activity and Functional indices (BASDAI and BASFI). We analysed data from a predominantly female cohort. Five hundred and 16 patients (male:female = 172:344) with SpA who were assessed at our clinic were asked to complete a questionnaire addressing data related to their disease onset (first symptom at presentation, age at which the first symptom presented, age of diagnosis, and delay in diagnosis), clinical presentation (main problem the disease caused them, night pain/sleep disturbance, well-being over the past week, and well-being over the previous 6 months), disease activity indices (erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and BASDAI), and functional index (BASFI). Compared with men, women had greater age at presentation, longer disease duration, more delayed diagnoses and greater age at diagnosis. Back pain was the main presenting symptom equally distributed for both genders. Women had more neck, knee and hip pain as presenting symptoms, while men experienced more feet pain. Back pain is also the main problem that the disease is causing to both sexes. More women had lower back pain, fatigue, neck pain, and pain with pressure as the main problems caused by the disease, while men had more joint pains. Women had significantly greater night pain and sleep disturbance than men. Furthermore, they experienced a worse well-being over past week and over past 6 months in addition to a higher mean ESR (P < 0.005), CRP (NS), BASDAI (P < 0.005) and BASFI (P < 0.05) scores. With regard to the items of the BASDAI index, it displays that women experienced significantly more fatigue (BASDAI 1; P < 0.001), total back pain (BASDAI 2; P < 0.05), and longer duration of morning stiffness (BASDAI 6; P = 0.09). With regard to the items of the BASFI index, women showed greater difficulty in reaching high shelves (BASFI 3; P < 0.001), getting up from the floor when lying on their back (BASFI 5; P < 0.001), and looking over their shoulders (BASFI 8; P < 0.05). SpAs present and progress differently in men and women. Women have more neck, knee, and hip pain at presentation and their main problems arise from the neck, back (lower and upper), fatigue and enthesitis during the course of the disease, whilst in men, feet pain was reported more often as presenting symptom than in women, with joint pain being the main problem caused by the disease.     

Multicenter validation of the value of BASFI and BASDAI in Chinese ankylosing spondylitis and undifferentiated spondyloarthropathy patients

The objectives of this study were to evaluate the reliability of Bath ankylosing spondylitis functional index (BASFI) and Bath ankylosing spondylitis disease activity index (BASDAI) in Chinese ankylosing spondylitis (AS) and undifferentiated spondyloarthropathy (USpA) patients. 664 AS patients by the revised New York criteria for AS and 252 USpA patients by the European Spondyloarthropathy Study Group criteria were enrolled. BASDAI and BASFI questionnaires were translated into Chinese. Participants were required to fill in BASFI and BASDAI questionnaires again after 24?h. Moreover, BASDAI and BASFI were compared in AS patients receiving Enbrel or infliximab before and after treatment. For AS group, BASDAI ICC: 0.9502 (95% CI: 0.9330?C0.9502, ???=?0.9702), BASFI ICC: 0.9587 (95% CI: 0.9521?C0.9645, ???=?0.9789). For USpA group, BASDAI ICC: 0.9530 (95% CI: 0.9402?C0.9632, ???=?0.9760), BASFI ICC: 0.9900 (95% CI: 0.9871?C0.9922, ???=?0.9950). In the AS group, disease duration, occipital wall distance, modified Schober test, chest expansion, ESR, and CRP showed significant correlation with BASDAI and BASFI (all P?<?0.01). In the USpA group, onset age, ESR, and CRP were significantly correlated with BASDAI (all P?<?0.05), while modified Schober test, ESR, and CRP were significantly associated with BASFI (all P?<?0.05). The change in BASDAI and BASFI via Enbrel or infliximab treatment showed a significant positive correlation (P?<?0.01). The two instruments have good reliability and reference value regarding the evaluation of patient??s condition and anti-TNF-?? treatment response.     

The Turkish versions of the Bath Ankylosing Spondylitis and Dougados Functional Indices: reliability and validity

Objective The aim of this study was to develop a Turkish version of the Bath Ankylosing Spondylitis Functional Index (BASFI) and Dougados Functional Index (DFI) and assess their reliability, validity, and sensitivity to change.Methods The Turkish versions of the BASFI and DFI were obtained after a translation and back-translation process. Seventy-one patients with ankylosing spondylitis (AS) were included in the study. For investigation of the reliability of the BASFI and DFI, 36 of the patients recompleted both indices on the following day. To assess validity, the patients were evaluated with the Bath AS Disease Activity Index (BASDAI), Bath AS Metrology Index (BASMI), Bath AS Patient Global Score (BAS-G), physicians assessment of disease activity, Bath AS Radiology Index-spine (BASRI-s) and sacroiliac joints, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). To assess the sensitivity to change, 16 patients were included in an 8-week home exercise program. In addition, 16 who had been on nonsteroidal anti-inflammatory drug (NSAID) treatment were requested to stop the treatment for 1 to 2 weeks.Results There were no significant differences in BASFI and DFI scores on two occasions within 24 h (P>0.05). The results showed correlations between both of the functional indices and the aforementioned validation parameters except ESR, CRP, and radiologic changes in the sacroiliac joints. The BASFI and DFI scores and BASMI and BASDAI values showed significant improvements in the home-exercise group. For the group of patients whose NSAIDs were stopped, BASFI, DFI, and BASDAI scores showed significant increase, whereas the mean BASMI score did not change.Conclusion The results indicate that the Turkish versions of the BASFI and DFI are reliable, valid, and sensitive to change.     

Comparison of the Bath Ankylosing Spondylitis Radiology Index and the modified Stoke Ankylosing Spondylitis Spine Score in Turkish patients with ankylosing spondylitis

The objective of the present study was to compare two radiographic scoring methods (the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) and the Bath Ankylosing Spondylitis Radiology Index-spine (BASRI-spine)) in terms of reliability, construct validity, and feasibility in Turkish ankylosing spondylitis (AS) patients. The study involved seventy-four patients. The patients were evaluated with 100-mm visual analog scale (VAS) for pain, global assessment of patient, and global assessment of doctor. The laboratory evaluations of patients comprised erythrocyte sedimentation rate and serum C-reactive protein. Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), Bath AS Metrology Index (BASMI), and Bath AS Radiology Index (BASRI) were calculated. Bilateral cervical, lumbar spine, and anteroposterior pelvis radiographs of all patients were obtained and evaluated by two radiologists. Each radiograph was scored by two scoring methods, mSASSS and BASRI-spine, and these methods were tested according to the aspects of the Outcome Measures in Rheumatology Clinical Trials filter: reliability, construct validity, and feasibility. The BASRI-spine reached intra- and interobserver intraclass correlation coefficient (ICC) of 0.726 and 0.689, respectively. The mSASSS scores more reliable, with ICC of 0.831 and 0.840, respectively. The BASMI and BASFI correlated significantly with the two scoring systems, respectively (mSASSS r: 0.557, r: 0.319; BASRI-spine r: 0.605, r: 0.285). For the two methods, the magnitude of the correlation with disease duration was similar (mSASSS p < 0.01 and BASRI p < 0.01), but no significant correlation was observed when compared to the BASDAI. It is known that the BASRI-spine is a feasible method that reliably detects damage in patients with AS. However, the present authors believe that, in AS patients, mSASSS should be the radiological scoring method to choose because of less radiation exposure, along with excellent intra- and interobserver reliability.     

The influence of peripheral arthritis on disease activity in ankylosing spondylitis patients as measured with the Bath Ankylosing Spondylitis Disease Activity Index

OBJECTIVES: To assess the differences in disease activity as measured by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) between patients with and without peripheral arthritis/enthesitis. To investigate whether scores on the BASDAI change by omitting the 2 questions on peripheral disease. METHODS: Disease activity was assessed on a 10-cm visual analog scale and by BASDAI. Alternative BASDAIs were constructed by omitting the peripheral joints question and/or the enthesitis question. Correlations between the alternative BASDAIs and other measures of disease activity were calculated. Generalized estimating equations (GEE) were used to assess whether having peripheral arthritis influenced BASDAI and alternative BASDAI scores, and to assess whether peripheral arthritis influenced the score of the individual questions of the BASDAI. RESULTS: At baseline, the BASDAI was calculated in 214 patients. In patients with peripheral arthritis (n = 56), the mean (SD) BASDAI score was 4.4 (2.3) as compared with 3.1 (1.9) (P < 0.0001) in the patients without peripheral arthritis (n = 158). The relationship between arthritis and the BASDAI score appeared to be truly longitudinal (GEE regression coefficient beta = 0.64; 95% confidence interval 0.28-1.00). Peripheral arthritis was significantly longitudinally associated with all separate item scores of the BASDAI. Omitting the peripheral joints and/or enthesitis question from the BASDAI questionnaire only partially explained the difference in BASDAI score between the 2 groups. CONCLUSION: Disease activity measured by the BASDAI is higher in patients with concomitant peripheral disease compared with patients with disease restricted to the axial skeleton. The increased BASDAI score in patients with peripheral arthritis is partially explained by increased overall disease activity as well as by a disproportionate contribution of the peripheral joints question to the overall score.     

Defining disease activity in ankylosing spondylitis: is a combination of variables (Bath Ankylosing Spondylitis Disease Activity Index) an appropriate instrument?

OBJECTIVE: Disease activity has been defined using a self-administered instrument, focusing on fatigue, axial pain, peripheral pain, enthesopathy and morning stiffness [Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)]. This validated instrument is simple and takes 40 s to complete, but whether the index is an accurate expression of the component parts, or whether additional weighting would enhance its efficacy, is unclear. METHODS: Four hundred and seventy-three patients with ankylosing spondylitis received placebo or active non-steroidal anti-inflammatory drug (NSAID) for 6 weeks, and changes between entry and completion were captured by BASDAI and the individual components. Principle component analysis (PCA) was used to explore the best combinations of variables in decreasing order of explained total dispersion and to assess whether a single sum (or algebraic expression) best defined disease activity status. RESULTS: At entry, the correlation between BASDAI and the first axis was 0.99, 0.11 with the second, and zero thereafter. Data at study end and relating to change revealed a 100% correlation (R = 1) between the first axis and the sum, with zero for the remainder. CONCLUSIONS: The data support BASDAI as being a valid and appropriate composite to define disease activity in ankylosing spondylitis. Developed as a simple sum of its components, BASDAI has excellent content validity.     

Comparison of group-based exercise versus home-based exercise in patients with ankylosing spondylitis: effects on Bath Ankylosing Spondylitis Indices,quality of life and depression

The objective of this non-randomised controlled trial was to evaluate the impact of group-based exercise programme and a home-based exercise programme on Bath Ankylosing Spondylitis Indices, depression and quality of life in patients with ankylosing spondylitis (AS). Approximately 41 patients in a rehabilitation unit were divided into two groups, either group- or home-based exercise programme. Exercise sessions were performed three times a week for a period of 6 weeks. The patients were compared before and after the rehabilitation programme, with respect to Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Disease Assessment Index (BASDAI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Beck Depression Inventory (BDI) and The Nottingham Health Profile (NHP). A statistically significant improvement was observed on BASDAI, BASMI and energy, pain, reaction of emotional and sleep subscores of NHP in both exercise groups after the exercise programme (p < 0.05). No statistically significant changes were detected in BASFI, BDI and social and mobility subscores of NHP in both exercise groups (p > 0.05). No statistically significant differences were found between the two exercise programmes (p > 0.05). Group and home-based exercise programmes are efficient in improving symptoms and mobility and had an important effect on quality of life in patients with AS. Home-based exercise programme, as it is cheaper, more easily performed and efficient, may be preferable for the management programme in AS.     

Estimation of the Bath Ankylosing Spondylitis Disease Activity Index cutoff for perceived symptom relief in patients with spondyloarthropathies

OBJECTIVE: To estimate the best Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) cutoff based on patients' perceptions of symptom relief collected in a large population of patients with spondyloarthropathies (SpA), in comparison to the BASDAI cutoff determined by experts. METHODS: A survey of patient perceptions about current disease control was conducted among the members of Spondylis, one of the main not-for-profit SpA patient organizations in France. BASDAI was among data collected by the questionnaire. To estimate the best BASDAI cutoff for discriminating between poor and well perceived controlled groups, we plotted the receiver operating characteristic (ROC) curve. We also determined the cutoff separately in male and female patients. RESULTS: Of the 1000 mailed questionnaires, 485 were returned without any missing data regarding perceived disease control and the BASDAI. Of these patients, 55.3% perceived inadequate control of their disease. The mean BASDAI in the overall population was 43.5 +/- 22.9, 30.4 +/- 19.9 in the well controlled group and 54 +/- 19.4 in the poorly controlled group (p < 0.001). The best BASDAI cutoff for discriminating between patients in the 2 groups was 39 (sensitivity 74.6% and specificity 72.4%). According to gender, the best cutoff was 44 for women and 36 for men. CONCLUSION: The best BASDAI cutoff of 39 based on patients' perceptions was very similar to that selected by international experts, i.e., 40. Gender affected the cutoff for perceived symptom relief in our study. These results need to be confirmed by further studies collecting the opinions of both patients and physicians.