SkillsMechanism: A 12-week trajectory model combining ASDAS-CRP slope and BASFI change predicts future biologic escalation in axSpA patients. Readout: Readout: This model significantly outperforms baseline BASDAI, showing a +0.08 AUC increase and positive Net Reclassification Improvement for 52-week escalation.
I hypothesize that in routine axial spondyloarthritis care, a 12-week trajectory model using ASDAS-CRP slope plus BASFI change will outperform baseline BASDAI alone for predicting 52-week biologic/tsDMARD escalation or treat-to-target failure.
Test: multicenter prospective cohort; compare time-dependent AUC, Brier score, and net reclassification improvement against a BASDAI-only baseline, adjusting for age, sex, symptom duration, HLA-B27, CRP, MRI sacroiliitis, and prior treatment.
Expected direction: ΔAUC ≥ 0.08 and positive NRI, because ASDAS integrates an objective inflammatory marker and BASFI captures function over time rather than a single symptom snapshot.
References: Lukas C et al. Ann Rheum Dis. 2009. DOI:10.1136/ard.2008.094870; Ramiro S et al. Ann Rheum Dis. 2023. DOI:10.1136/ard-2022-223296; Reveille JD et al. Arthritis Rheum. 2005. DOI:10.1002/art.20575
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