Background: Assessment of axial spondyloarthritis (axSpA) in clinical practice, addressing the patient’s current disease status and impact on outcomes, is essential to guide appropriate treatment and prevent progression of structural damage and functional impairment (1). However, limitations in time and resources, as well as restrictions in the local context of certain healthcare facilities, constrain the extent to which these assessments can take place in daily practice, and impact the choice of domains and instruments applied.

The ASAS-EULAR recommendations and ASAS quality standards advocate periodic evaluations of patients with axSpA in clinical practice (1, 2). Ideally, outcome measures used for these assessments should reflect the status and impact of disease manifestations, match the preferences of healthcare providers and patients, and be feasible in daily practice (1, 3). However, internationally endorsed recommendations on what, how and when to measure are currently lacking, leading to a large heterogeneity in the assessment if axSpA in practice (1). There is need for guidance on these systematic evaluations, taking into account constraints in time and resources experienced by healthcare services.

Aim: To formulate recommendations for a standardised and pragmatic disease assessment of axSpA in daily clinical practice, specifically aiming to describe a minimum set of domains to be assessed with associated instruments and ensuring its feasibility.

Methods: Following the approval of this project in September 2024, a protocol was written and a steering committee and working group (including two members of Young-ASAS and two patient representatives from ASIF) was established. The project consists of:

• A scoping literature review to (1) identify domains that may be considered in the assessment of rheumatic and musculoskeletal diseases, and (2) evaluate the implementation of these domains in clinical practice (e.g. frequency of measurement). The results of this literature review were discussed with the working group in January 2025 and presented at the 2025 ASAS annual meeting.
• Three Delphi survey rounds, which will be composed based on the results of the scoping review and discussion at the 2025 ASAS annual meeting. In the first round, the most clinically relevant domains will be selected, and in the second round, instruments to measure these domains. The third round is intended for final prioritisation of the domains/instruments with emphasis on feasibility. All ASAS members, approximately 100 non-ASAS member rheumatologists, and approximately 100 patients will be invited to participate.
• Drafting of a recommendation by the steering committee based on the Delphi exercise, and discussion and adaptation of the draft within the working group.
• Presentation of the proposal at the 2026 ASAS annual meeting for final discussion, voting and endorsement.

Timelines of the project: 2024 – 2026

Project team: 

PIs:

Astrid van Tubergen (Maastricht, The Netherlands)

Victoria Navarro-Compán (Madrid, Spain)

Fellow:

Marius Smits (Maastricht, The Netherlands)

Steering committee:

Xenofon Baraliakos (Herne, Germany)

Anna Moltó (Paris, France)

Elena Nikiphorou (London, United Kingdom)

Working group:

Wilson Bautista-Molano (Bogotá, Colombia)

Philippe Carron (Ghent, Belgium)

Adrian Ciurea (Zurich, Switzerland)

Jo Davies (London, United Kingdom, ASIF)

Warren Fong (Singapore)

Rodrigo García-Salinas (Buenos Aires, Argentina)

Laure Gossec (Paris, France)

Désirée van der Heijde (Leiden, The Netherlands)

David Kiefer (Herne, Germany, Y-ASAS)

Uta Kiltz (Herne, Germany)

Yu Heng Kwan (Singapore, Y-ASAS)

Jo Lowe (London, United Kingdom, ASIF)

Marina Magrey (Cleveland, United States of America)

Denis Poddubnyy (Toronto, Canada)

Sofia Ramiro (Leiden/Heerlen, The Netherlands)

Alexandre Sepriano (Lisbon, Portugal)

Nelly Ziade (Beirut, Lebanon)

References:

(1) Ramiro S, Nikiphorou E, Sepriano A, Ortolan A, Webers C, Baraliakos X, et al. ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update. Ann Rheum Dis. 2023;82(1):19-34.

(2) Kiltz U, Landewé RBM, van der Heijde D, Rudwaleit M, Weisman MH, Akkoc N, et al. Development of ASAS quality standards to improve the quality of health and care services for patients with axial spondyloarthritis. Ann Rheum Dis. 2020;79(2):193-201.

(3) Navarro-Compán V, Boel A, Boonen A, Mease P, Landewé R, Kiltz U, et al. The ASAS-OMERACT core domain set for axial spondyloarthritis. Semin Arthritis Rheum. 2021;51(6):1342-9.