ASDAS calculator - ASAS https://www.asas-group.

org/instruments/asdas-calculator/

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ASDAS calculator

Download the ASAS app with an ASDAS calculator from the App Store or Google Play

(https://itunes.apple.com/us/app/asdas-
(https://play.google.com/store/apps/details?
calculator/id650291528)
id=org.asas_group.asdas_calculator)

or use the online ASDAS calculator below:

Click on the button to load the content from ijon.charite.de.

Load content

You can also:

• Download the ASDAS calculator for Windows (https://www.asas-group.org/wp-content/uploads/

2020/07/ASDAS.exe)
• Download the quick ASDAS-CRP calculation form (https://www.asas-group.org/wp-content/
uploads/2020/07/Quick_ASDAS-CRP_Calculation_Form.pdf)
• Download the quick ASDAS-ESR calculation form (https://www.asas-group.org/wp-content/
uploads/2023/05/Quick_ASDAS-ESR_Calculation_Form.pdf)
• Download supplementary material on ASDAS calculation (https://www.asas-group.org/wp-
content/uploads/2020/07/Quick_ASDAS-CRP_Calculation_Form.pdf)

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Ankylosing Spondylitis Disease Activity Score

The Ankylosing Spondylitis Disease Activity Score (ASDAS) is a new composite index to assess
disease activity in Ankylosing Spondylitis (AS)1. It combines five disease activity variables with only
partial overlap, resulting in one single score with better truth (validity), enhanced discriminative
capacity and improved sensitivity to change as compared to single-item variables (1,2).

Table 1. The two ASDAS formulas: ASDAS-CRP (preferred) and ASDAS-ESR (alternative).

ASDAS-CRP 0.12 x Back Pain + 0.06 x Duration of Morning Stiffness + 0.11 x Patient
Global + 0.07 x Peripheral Pain/Swelling + 0.58 x Ln(CRP+1)

ASDAS-ESR 0.08 x Back Pain + 0.07 x Duration of Morning Stiffness + 0.11 x Patient
Global + 0.09 x Peripheral Pain/Swelling + 0.29 x √(ESR)

ASDAS, Ankylosing Spondylitis Disease Activity Score; √(ESR), square root of the erythrocyte
sedimentation rate (mm/h); Ln(CRP+1), natural logarithm of the C-reactive protein (mg/L) + 1.
Back pain, patient global, duration of morning stiffness and peripheral pain/swelling are all
assessed on a visual analogue scale (from 0 to 10cm) or on a numerical rating scale (from 0 to
10). Back pain, BASDAI question 2: “How would you describe the overall level of AS neck, back
or hip pain you have had?”. Duration of morning stiffness, BASDAI question 6: “How long does
your morning stiffness last from the time you wake up?”. Patient global: “How active was your
spondylitis on average during the last week?” Peripheral pain/swelling, BASDAI question 3: “How
would you describe the overall level of pain/swelling in joints other than neck, back or hips you
have had?”

The Assessment of SpondyloArthritis international Society (ASAS) membership has selected the
ASDAS containing C-reactive protein (CRP, mg/l) as acute phase reactant as the preferred version,
and the one with erythrocyte sedimentation rate (ESR, mm/hr) as the alternative version. Apart from
the value of CRP or ESR, the four additional self-reported items included in this index are back pain
(0-10cm, visual analogue scale [VAS] or 0-10, numerical rating scale [NRS]), duration of morning

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stiffness (VAS/NRS), peripheral pain/swelling (VAS/NRS) and patient global assessment of disease
activity (VAS/NRS) (table 1) (1,2).
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The next step to consolidate the ASDAS as an instrument to measure disease activity in AS was the
development of cut-offs for disease activity states and improvement scores. During the 2010 ASAS
workshop in Berlin, Germany, cut-offs for the ASDAS were proposed, and cross-validation studies
were presented. The methodology and the results were debated by ASAS members and four disease
activity states were chosen by consensus: “inactive disease”, “moderate disease activity”, “high
disease activity” and “very high disease activity”.

The 3 cut-offs selected to separate these states (figure 1) were: <1.3 between “inactive disease” and
“low disease activity”, <2.1 between “moderate disease activity” and “high disease activity”, and
>3.5 between “high disease activity” and “very high disease activity” (3,4).

Selected cut-offs for improvement scores (figure 2) were: a change ≥1.1 units for “clinically important
improvement” and a change ≥2.0 units for “major improvement” (3).

Figure 1. Selected cut-offs for disease activity states.

Figure 2. Selected cut-offs for improvement scores.

At the Outcome Measures in Rheumatology (OMERACT) 10 conference, in Kota Kinabalu, Malaysia,

the ASDAS disease activity states and response criteria also obtained the endorsement from
OMERACT (5).

Using the ASDAS and the newly validated cut-off values, we hope that clinicians can better assess
the effectiveness of treatments and determine whether they are providing clinically meaningful
improvement. The higher discriminatory capacity of the ASDAS compared to classical response
criteria in AS may have important implications in reducing sample size calculation for clinical trials.
The ASDAS will also allow clinicians, investigators, regulators, and patients to continue
communicating about treatment response using the same metric.

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References

1. Lukas C, Landewé R, Sieper J, Dougados M, Davis J, Braun J, van der Linden S, van der
Heijde D. Development of an ASAS-endorsed disease activity score (ASDAS) in patients with
ankylosing spondylitis. Ann Rheum Dis 2009;68:18-24. (Toll-Free Link) (http://ard.bmj.com/cgi/
content/full/ard.2008.094870?ijkey=vvTs0cIdrHwBE&keytype=ref&siteid=bmjjournals)
2. van der Heijde D, Lie E, Kvien TK, Sieper J, van den Bosch F, Listing J, Braun J, Landewé R.
ASDAS, a highly discriminatory ASAS-endorsed disease activity score in patients with
ankylosing spondylitis. Ann Rheum Dis 2009;68:1811-8. (Toll-Free Link) (http://ard.bmj.com/cgi/
content/full/ard.2008.100826?ijkey=Cdkyfv5GxH69E&keytype=ref&siteid=bmjjournals)
3. Machado P, Landewé R, Lie E, Kvien TK, Braun J, Baker D, van der Heijde D. Ankylosing
Spondylitis Disease Activity Score (ASDAS): defining cut-off values for disease activity states
and improvement scores. Ann Rheum Dis 2011;70:47-53. (Toll-Free Link) (http://ard.bmj.com/
cgi/content/full/ard.2010.138594?ijkey=qaS5KCQebRW2w&keytype=ref&siteid=bmjjournals)
4. Machado PM, Landewé R, van der Heijde DV. Assessment of SpondyloArthritis international
Society (ASAS). Ankylosing Spondylitis Disease Activity Score (ASDAS): 2018 update of the
nomenclature for disease activity states. Ann Rheum Dis. 2018 Feb 16. doi: 10.1136/
annrheumdis-2018-213184. [Epub ahead of print] (Toll-Free Link) (http://ard.bmj.com/cgi/
content/full/annrheumdis-2018-213184?
ijkey=w1wFNSuoT8duM&keytype=ref&siteid=bmjjournals)
5. Machado P, Landewé R, van der Heijde D. Endorsement of the definitions of disease activity
states and improvement scores for the Ankylosing Spondylitis Disease Activity Score (ASDAS):
results from the Outcome Measures in Rheumatology (OMERACT) 10 conference. J Rheumatol
2011;38:1502-6. (https://www.ncbi.nlm.nih.gov/pubmed/21724723)

Contact
ASAS

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Korte Raarberg 46

6231 KR Meerssen

The Netherlands (NL)

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Administrative secretary:

Femke Hoekstra

(secretary to the ASAS president)

Sandra Meeuwissen

(assistant to the ASAS-treasurer)

Note
Please send documents regarding finances to the ASAS-treasurer.

Floris van Gaalen

Dept. of Rheumatology, C-01-038

Postbus 9600, 2300 RC Leiden

asas@lumc.nl

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