Spine transforming into flowers, symbolizing remission from ankylosing spondylitis

Unlocking Remission: What Predicts Success in Ankylosing Spondylitis Treatment?

Samir D’Costa in Health & Wellness November 2025 • 4 min read.

"A Comprehensive Guide to Factors Influencing Partial Remission with Anti-TNFα Therapy"

Ankylosing spondylitis (AS) is a chronic inflammatory disease primarily affecting the spine and sacroiliac joints, leading to pain, stiffness, and reduced mobility. For many years, managing AS focused on alleviating symptoms, but recent advances have shifted the focus toward achieving disease remission. Remission, whether complete or partial, represents a significant improvement in a patient's quality of life, allowing them to experience less pain and improved function.

Tumor necrosis factor alpha (TNFα) inhibitors have revolutionized the treatment of AS, offering many patients significant relief from their symptoms. These drugs work by blocking the action of TNFα, a key protein that drives inflammation in AS. While anti-TNFα therapies are effective for many, not everyone achieves the same level of success. Some patients experience complete remission, while others achieve only partial remission, and some, unfortunately, do not respond at all. Therefore, identifying factors that predict who will respond best to these treatments is of utmost importance.

The Ankylosing Spondylitis Assessment Study (ASAS) working group has proposed criteria for defining partial remission (PR) in AS. These criteria involve achieving low scores in several key areas, including patient global assessment, pain, function, and inflammation. Understanding the factors that contribute to achieving PR can help doctors make more informed treatment decisions, personalize therapy, and ultimately improve outcomes for people living with AS.

Key Predictors of Partial Remission in Ankylosing Spondylitis

Spine transforming into flowers, symbolizing remission from ankylosing spondylitis

A recent study published in Reumatismo sought to identify predictive factors for achieving partial remission (PR) in patients with AS treated with anti-TNFα drugs. This multi-center, longitudinal study enrolled 214 AS patients who were treated with adalimumab (ADA), etanercept (ETA), or infliximab (INF) and followed for at least 12 months. The researchers analyzed various demographic, clinical, and laboratory parameters to determine which factors were associated with a higher likelihood of achieving PR.

The study defined PR according to ASAS criteria, requiring patients to achieve a score of less than 20 mm (on a 0-100 mm visual analogue scale) in each of the following four domains:

Patient global assessment (in the last week)
Pain (spinal pain)
Function [measured by the Bath Ankylosing Spondylitis Functional Index (BASFI)]
Inflammation [mean of intensity and duration of morning stiffness from the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)]

The results of the study revealed several significant predictors of PR. These findings offer valuable insights for clinicians and patients alike, helping to optimize treatment strategies and manage expectations. Let’s delve into the key predictors identified:

Empowering Patients Through Knowledge

Understanding the factors that influence treatment outcomes in ankylosing spondylitis is crucial for both patients and healthcare providers. By recognizing the importance of early intervention, managing inflammation, and considering individual patient characteristics, we can work towards optimizing treatment strategies and improving the lives of those living with this chronic condition. While this study sheds light on important predictors, further research is always ongoing. Stay informed, stay proactive, and work closely with your healthcare team to achieve the best possible outcome.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.4081/reumatismo.2014.756, Alternate LINK

Title: Predictive Factors For Partial Remission According To The Ankylosing Spondylitis Assessment Study Working Group In Patients With Ankylosing Spondylitis Treated With Anti-Tnfα Drugs

Subject: Rheumatology

Journal: Reumatismo

Publisher: PAGEPress Publications

Authors: F.M. Perrotta, O. Addimanda, R. Ramonda, S. D’Angelo, E. Lubrano, A. Marchesoni, I. Olivieri, L. Punzi, C. Salvarani, A. Spadaro

Published: 2014-11-06

Everything You Need To Know

What is ankylosing spondylitis and how do TNFα inhibitors help?

Ankylosing spondylitis (AS) is a chronic inflammatory condition primarily affecting the spine and sacroiliac joints, leading to pain, stiffness and reduced mobility. TNFα inhibitors are often prescribed. These medications function by targeting and blocking tumor necrosis factor alpha (TNFα), a protein instrumental in driving inflammation associated with AS.

How is partial remission defined in ankylosing spondylitis according to ASAS criteria, and what key areas are assessed?

Partial remission (PR) in ankylosing spondylitis, as defined by the ASAS criteria, requires a patient to achieve low scores (less than 20 mm on a 0-100 mm visual analogue scale) in several key areas: patient global assessment, pain (spinal pain), function (measured by the Bath Ankylosing Spondylitis Functional Index - BASFI), and inflammation [mean of intensity and duration of morning stiffness from the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)]. Failing to meet the threshold in one of these areas means remission has not been achieved.

What are adalimumab, etanercept and infliximab and how effective are they in achieving remission?

Adalimumab (ADA), etanercept (ETA), and infliximab (INF) are anti-TNFα drugs used in the treatment of ankylosing spondylitis. They function by inhibiting TNFα, a key protein that drives inflammation in AS. However, it's important to note that not everyone responds the same way to these treatments; some may experience complete remission, others partial remission, and some may not respond at all.

What role does the Bath Ankylosing Spondylitis Functional Index (BASFI) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) play in assessing ankylosing spondylitis?

The Bath Ankylosing Spondylitis Functional Index (BASFI) plays a role in measuring function and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) assessing inflammation. Both tools are components of the ASAS criteria. The BASFI assesses the degree of functional limitation caused by ankylosing spondylitis, while the BASDAI measures disease activity based on symptoms like fatigue, spinal pain, and morning stiffness. Both scores must be below 20mm (on a 0-100 mm visual analogue scale).

How does achieving partial remission with anti-TNFα therapy impact the life and well-being of someone with ankylosing spondylitis?

Achieving partial remission through anti-TNFα therapy significantly improves the quality of life for individuals. Reduced pain, enhanced physical function, and decreased disease activity collectively contribute to a better overall well-being. Although not a cure, partial remission represents a notable stride toward effectively managing ankylosing spondylitis and mitigating its impact on daily life. While this improves patient well being, more data needs to be collected to access long term effect.