Monitoring
Clinical outcomes should be measured annually to monitor disease progression and identify those with rapidly progressive disease. All patients with AS should be routinely assessed for cardiovascular risk, and modifiable risk factors should be aggressively treated.[124]
The Assessment in Ankylosing Spondylitis (ASAS) International Working Group has identified key variables to be measured:[88]
Patient global assessment: measured using a single 100 mm visual analogue scale
Spinal pain and stiffness: assessed using the last 2 questions of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)
Spinal mobility: assessed using the Bath Ankylosing Spondylitis Metrology Index (BASMI); one systematic review and meta-analysis has demonstrated that the BASMI correlates with the degree radiographical structural damage but not the level of inflammation in either the spine or sacroiliac joints and, as such, regular monitoring of the BASMI provides a surrogate marker of disease damage[244]
Physical function: assessed using the Bath Ankylosing Spondylitis Functional Index (BASFI), a 10-question patient-completed questionnaire
Peripheral joints: assessment of enthesitis and requires a clinical examination
Fatigue.
The Ankylosing Spondylitis Disease Activity Score (ASDAS) combines an assessment of back pain, duration of morning stiffness, patient global assessment, peripheral joint swelling/pain, and acute-phase response (either erythrocyte sedimentation rate or C-reactive protein) to provide a numerical indicator of disease activity.[245]
Imaging studies
Radiographs of the pelvis and the cervical, thoracic, and lumbar spines should be performed on a regular basis to monitor progression of disease but no more frequently than every 2 years unless a specific clinical indication is present that requires investigation, such as a history of a fall.
Drug monitoring
In patients taking disease-modifying drugs such as sulfasalazine and methotrexate for treatment of peripheral disease manifestations, blood tests (including full blood count [FBC], renal function, and liver function) should be monitored regularly.[246]
All patients being treated with biological DMARDs should be reviewed for drug safety in a consultant department at least every 6 months. High-risk patients (e.g., those at high risk of TB) should be reviewed every 3 months.[153]
Patients taking regular non-steroidal anti-inflammatory drugs should have their renal and liver function monitored periodically.
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