Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) Score

Evaluates disease activity in Ankylosing Spondylitis based on major symptoms of this rheumatological condition.

Refer to the text below the calculator for more information about the index and its clinical use.

 


The use of the Bath Indices (in particular the BASDAI) is a key feature in the NICE criteria for anti-TNF medications for the treatment of Ankylosing Spondylitis in the UK.

BASDAI scores of 4 or greater are internationally recognised to suggest suboptimal control of disease. These patients may be candidates for new medical therapy or enrolment in clinical trials.


BASDAI evaluates six dimensions of Ankylosing Spondylitis:

  • Fatigue;
  • Spinal pain;
  • Joint pain / swelling;
  • Areas of localized tenderness;
  • Morning stiffness duration;
  • Morning stiffness severity.

Instruction: Please indicate your level of ability with each of the following activities during the past week.

1How would you describe the overall level of fatigue/tiredness you have experienced?
0
None (0) Very Severe (10)
2How would you describe the overall level of AS neck, back or hip pain you have had?
0
None (0) Very Severe (10)
3How would you describe the overall level of pain/swelling in joints other than neck, back or hips you have had?
0
None (0) Very Severe (10)
4How would you describe the overall level of discomfort you have had from any areas tender to touch or pressure?
0
None (0) Very Severe (10)
5How would you describe the overall level of discomfort you have had from the time you wake up?
0
None (0) Very Severe (10)
6How long does your morning stiffness last from the time you wake up?
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BASDAI Explained

The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) is simple and quick to administer and helps evaluate disease activity in six dimensions, as follows:

  • Fatigue;
  • Spinal pain;
  • Joint pain / swelling;
  • Areas of localized tenderness (also called enthesitis, or inflammation of tendons and ligaments);
  • Morning stiffness duration;
  • Morning stiffness severity.

The first five items consist of a visual analogue scale 1 to 10 scale, where 1 indicates no problem and 10 indicates the most severe problem. The sixth item, related to the duration of morning stiffness is scored as 0 for 0 hours, 5 for one hour and 10 for two or more hours.

The total score is computed by:

BASDAI = ((Q1 + Q2 + Q3 + Q4) + ((Q5 + Q6) / 2)) / 5

BASDAI scores of 4 or greater are internationally recognised to suggest suboptimal control of disease. These patients may be candidates for new medical therapy or enrolment in clinical trials.

Calin et al. demonstrated that the individual symptoms and the index as a whole demonstrated good score distribution, using 95% of the scale.

BASDAI demonstrated statistically significant (p<0.001) reliability.

BASDAI may be used to monitor disease activity in time and response to treatment as it has demonstrated a sensitivity to change (i.e. in a group of 154 patients, following a 3 week physiotherapy course, the BASDAI showed a significant (p=0.009) 16.4% score improvement).

In a subsequent study, the index’ content validity was further confirmed on a cohort of 473 patients with AS who received placebo or active non-steroidal anti-inflammatory drug (NSAID) for 6 weeks and evaluated as start and end of trial.

The use of the Bath Indices (in particular the BASDAI) is a key feature in the NICE criteria for anti-TNF medications for the treatment of AS in the UK.

Another index (also part of the Bath indices) for use in evaluating Ankylosing Spondylitis is BASFI (Bath Ankylosing Spondylitis Functional Index) which determines the degree of functional limitation in those with AS.

 

References

Original reference

Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A. A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol. 1994; 21(12):2286-91.

Other references

Calin A, Nakache JP, Gueguen A, Zeidler H, Mielants H, Dougados M. Defining disease activity in ankylosing spondylitis: is a combination of variables (Bath Ankylosing Spondylitis Disease Activity Index) an appropriate instrument? Rheumatology (Oxford). 1999; 38(9):878-82.

Zochling J. Measures of symptoms and disease status in ankylosing spondylitis: Ankylosing Spondylitis Disease Activity Score (ASDAS), Ankylosing Spondylitis Quality of Life Scale (ASQoL), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Global Score (BAS-G), Bath Ankylosing Spondylitis Metrology Index (BASMI), Dougados Functional Index (DFI), and Health Assessment Questionnaire for the Spondylarthropathies (HAQ-S). Arthritis Care Res (Hoboken). 2011; 63 Suppl 11:S47-58.


Specialty: Disability

System: Musculoskeletal

Objective: Evaluation

Type: Index

No. Of Items: 6

Year Of Study: 1994

Abbreviation: BASDAI

Article By: Denise Nedea

Published On: February 4, 2021

Last Checked: February 4, 2021

Next Review: February 4, 2026