Sierra Rheumatology
Disease activity

BASDAI — Bath Ankylosing Spondylitis Disease Activity Index

Six self-rated questions about fatigue, pain, and stiffness over the past week.

About this form

The BASDAI is a six-item questionnaire used to assess disease activity in ankylosing spondylitis and related spondyloarthropathies. Please draw a mark on each line below to indicate your situation in the past 7 days.

About 3 minutes
Progress
0%
Patient information
Please indicate your situation in the past 7 days
1. How would you describe the overall level of fatigue / tiredness you have experienced in the past week? *
None
Very severe
2. How would you describe the overall level of AS neck, back or hip pain you have had in the past week? *
None
Very severe
3. How would you describe the overall level of pain / swelling in joints other than neck, back or hips you have had in the past week? *
None
Very severe
4. How would you describe the overall level of discomfort you have had in the past week from any areas tender to touch or pressure? *
None
Very severe
5. How would you describe the overall level of morning stiffness you have had in the past week from the time you wake up? *
None
Very severe
6. How long did your morning stiffness last from the time you wake up? *
0 hours
2 hours or more
Sign & submit
Patient signature *Sign with your finger, mouse or trackpad in the box below.
Sign here with your finger, mouse or trackpad

Your signature will appear on the exported PDF.

Acknowledgement. BASDAI = (sum of questions 1–4 plus mean of questions 5 and 6) divided by 5. Your provider will calculate this score after reviewing your submission.

Submitting transmits this form securely to our office. Export to PDF works even with partial answers — useful if you want a printed copy to bring in. For urgent medical issues, please call our office or 911.

Trouble with the form?

Call our office and we'll either walk you through it or send a paper version.

Call (916) 677-4744← All forms