Axial spondyloarthritis (axSpA) is a long-term disease that most commonly causes inflammation and pain in the spine and hips. Early in the disease course, axSpA causes lower back pain. Later on, a range of other problems can occur.1
Health problems that commonly occur with axSpA (called complications) include:1
- Morning stiffness
- Swelling and stiffness in other areas of the body
- Difficulty sleeping
- Inflammation of the eye (uveitis)
- Inflammatory bowel disease (IBD)
For some people, inflammation in the spine continues for a long time. This can cause the bones in the spine to join together (fuse), which makes it hard to move.1
However, because axSpA is an inflammatory disease, most people have symptoms that come and go. There are times when the pain, swelling, fatigue, and stiffness are stronger. This is called a flare. Other times, the symptoms are not as severe and are more like "background noise." This is called remission. Your doctor may also call these times low or minimal disease activity.1,2
The goal of treatment for axSpA is always remission. This allows you to have a better quality of life and preserve your ability to do things.1
Diagnosing remission
There is no single way to know if you are in remission from axSpA. Your doctor has different ways of deciding whether you have low disease activity. There are tools that help your doctor score your axSpA symptoms.1
Two of these tools are the older Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the newer Ankylosing Spondylitis Disease Activity Score (ASDAS).1
Bath Ankylosing Spondylitis Disease Activity Index
The BASDAI is a tool that measures the severity of your axSpA symptoms. It looks at 4 aspects of the disease:3
- Pain
- Stiffness
- Fatigue
- Other issues
Your doctor will ask questions about these 4 areas and score each one from 0 to 10. They will then add the scores together to get a total score. A lower score means less disease activity.1,3
Ankylosing Spondylitis Disease Activity Score
The ASDAS looks at axSpA symptoms in a different way. It measures a different 4 things:4
- The number of swollen and tender joints you have
- Your level of inflammation (C-reactive protein or CRP)
- Your ability to do activities like walking and dressing
- How you feel overall
The total score ranges from 0 to 10. A higher score means more disease activity.4
Your doctor will compare your BASDAI and ASDAS scores to see if you are in remission from axSpA. If your scores are low, that means your disease is less active. This may mean you can change your treatment plan.1,2
But your doctor will need to monitor you over time. They may adjust your treatment plan if your symptoms become more active again.1,2
Keeping track of your symptoms
It can be helpful to keep track of how often you have flares and remissions. You can use a symptom diary to help keep track of this information. Your doctor will also want you to communicate regularly with them about how active your axSpA is over time.5
Medicine and remission
If you are in remission, your doctor might want to change your treatment plan. But do not stop taking your medicines even if you are feeling better. It usually takes some time to find the right drug combination to prevent flares while reducing the side effects of the drugs. Work with your doctor to find the right strategy for you.6
Finally, remission does not mean you are cured. You will likely still have some symptoms, but they will be less severe than when the disease is active. Talk to your doctor about any changes in your health so that they can adjust your treatment plan as needed. With proper care and management, you can maximize your periods of remission.1,2,6