Critères de réponse dans les spondylarthropathies : définition d’un répondeur

Abstract

Therapy upsets of the ten last years have made necessary a better assessment of spondylarthropathies. Since the appearance of anti-TNFα drugs, it became determinant to assess disease activity and therapeutic response, both in real life and studies. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) is considered as the gold standard to assess disease activity for fifteen years. National and international recommendations use it to define the minimal disease activity required before the beginning of anti-TNFα drugs. Moreover, therapeutic response is defined by a variation of at least 20 mm by 100 or at least 50% of its initial value. Other response criteria as Assessment of SpondylArthritis international Society (ASAS) criteria have been created; initially ASAS 20 have been developed from NSAID studies, but ASAS 40 and 70 are more conformed to the frequency and the amplitude of response observed with anti-TNFα. Partial remission, as defined by ASAS group, charge even more and more interest and signification with these new treatments. Recently, a new disease activity score called ASAS-endorsed disease activity score (ASDAS) have been developed, with the same process than the Disease Activity Score (DAS) in rheumatoid arthritis. Contrary to BASDAI, it takes into account the biological inflammatory parameters. It should shortly permit to define reliable disease activity levels, and then, from variation of these levels, response criteria in the manner of European League Against Rheumatism (EULAR) response in rheumatoid arthritis.