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A similar trend of utilization was observed with the domain ‘spine radiograph’. With the expectation that there would be a positive effect by treatment on structural damage, it stimulated the inclusion of this domain in more recent trials. The domains ‘acute phase reactants’, ‘pain’, ‘spinal mobility’ and ‘spinal stiffness’ were already frequently used before the publication of the core sets and this has remained unchanged. The only domain that did not show an increased usage over time is ‘patient global assessment’ (61% for DC-ART and 36% for SMARD core set).
Regarding the specific instruments to measure each domain there is clearly more homogeneity, as non-endorsed instruments that were used frequently in the past are not used so often anymore after the introduction of the core set. Nevertheless, the overall level of implementation of specific instruments still leaves room for further improvement, especially for the SMARD core set.
A remarkable improvement in the usage of domains and instruments is attributable to RCTs with biological treatments, intended for drug registration purposes. These RCTs are usually of very high methodological quality, and trial planning teams that were responsible for the choice of primary and secondary outcome measures have scrutinized the literature to search for the best set of instruments. In this context the ASAS core-set as such, may have contributed to the performance of these trials, to a more transparent drug registration process and to a better acceptance of new treatments in the field.
The ASAS response and partial remission criteria are intended for use in the evaluation of drug treatment. Therefore, it could be expected that the best implementation is seen in trials evaluating biological therapies, and this is most obvious with regard to the use of the ASAS40 and ASAS5/6,
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