Value of Disease Activity Score 28 (DAS28) and DAS28-3 compared to American College of Rheumatology-defined remission in rheumatoid arthritis

OBJECTIVE: To assess the criteria for remission based on Disease Activity Score 28 (DAS28) and DAS28-3 (excluding patients' evaluation of disease activity) compared to American College of Rheumatology (ACR) preliminary criteria in established rheumatoid arthritis (RA), and to examine the value of each ACR criterion individually. METHODS: The EMECAR study was designed to assess the burden of comorbidity and inflammatory activity for RA in Spain. A random sample of 788 patients with RA from 34 Spanish centers was selected. Remission was defined by preliminary ACR criteria applied specifically and the clinical activity assessed by the DAS28 and the DAS28-3. A receiver operating characteristics curve analysis was performed to identify cutoff values with the highest usefulness in defining remission on both DAS indices. RESULTS: Thirty-two patients (4.1%) were in ACR-defined remission, 62 (7.9%) if fatigue was excluded from the criteria. The frequency of any single criterion that patients in remission fulfilled: no fatigue and joint pain by anamnesis in 31 patients (96.9%); morning stiffness < 15 min in 26 (81.3%); no swelling in joints in 21 (65.6%); normal erythrocyte sedimentation rate (ESR) in 29 (90.6%); and no joint tenderness in 21 (65.6%) patients. The positive predictive value for remission of each criterion: normal ESR 6.5%; morning stiffness < 15 min 8.4%; no fatigue 8.7%; no joint tenderness 13%; no swelling in joints 15.8%; and no joint pain by anamnesis 27.7%. The DAS28 cutoff values with higher discriminatory power for remission were 3.14 (sensitivity 87%; specificity 67%) when all the ACR criteria were used, and 2.81 (sensitivity 84%; specificity 81%) when fatigue was omitted. The equivalent cutoffs for the DAS28-3 were 3.52 (sensitivity 84%; specificity 66%) and 2.95 (sensitivity 82%; specificity 83%), respectively. CONCLUSION: DAS28 and DAS28-3 are good tools to define remission in established RA. No joint pain by anamnesis is the criterion with the highest value in defining remission, while normal ESR, an absence of morning stiffness, and fatigue are the least effective.     

CDAI (clinical disease activity index) in rheumatoid arthritis: cut-off values for classification into different grades of disease activity

BackgroundCDAI is a composite index for quantifying disease activity in RA. It utilises 4 clinical parameters namely, swollen and tender joints out of 28 (the set designated for DAS28) and global assessment of the patient and assessor on a visual analogue scale. No laboratory parameter is needed.ObjectiveTo determine cut-off values for CDAI (clinical disease activity index) in Indian patients with rheumatoid arthritis (RA) for classification into different grades of disease activity.MethodsCDAI and DAS28 (disease activity score on 28 joints) were measured at the first and again at the last clinic visit on 100 adult patients with RA seen over a period of 1½ years. Using recommended DAS28 values as a comparator for classifying patients into the following 4 categories of disease activity namely ‘remission’, ‘low disease activity’, ‘moderate disease activity, and ‘high disease activity’, the corresponding CDAI cut-off values were derived statistically.ResultsAmong Indian patients CDAI cut-off values for the classification of patients into 4 categories of disease activity were: remission ≤ 2.2, low disease activity > 2.2 to ≤ 5, moderate disease activity > 5 to ≤ 21 and high disease activity > 21.ConclusionsCDAI, a simple tool that is based on clinical parameters alone, was applied to the Indian patients with RA. The cut-off values derived in this study by a standardised assessment methodology could be useful in routine monitoring and therapeutic decisions in RA.     

Simplified Disease Activity Index as an index of disease activity in patients with rheumatoid arthritis: a comparison with DAS28

IntroductionVarious factors are known to determine the disease activity in patients with rheumatoid arthritis (RA). The main objective of this study was to establish the validity of the new tool of measurement of disease activity, Simplified Disease Activity Index (SDAI), in patients with RA in Indian population.MethodsAll patients with RA fulfilling the ACR classification criteria attending the rheumatology clinic at Nizam's Institute of Medical Sciences, Hyderabad over a period of 3 months were included in the study. A detailed assessment of each patient including their demographic characteristics, duration of the disease, number of tender and swollen joint counts, Westergren's ESR and C-reactive protein (mg/dL), patient's and physician's global assessment by VAS (0–10) were recorded. DAS28 and SDAI were calculated for each patient. Statistical analysis was done.ResultsTwo hundred and sixteen patients were included in the study comprising 184 women and 32 men. Mean age of the patients was 42.94 ± 11.23 years and mean duration of disease was 4.10 ± 4.02 years. Mean DAS28 and SDAI were 5.19 ± 1.48 and 24.2 ± 16.06 respectively. ROC curve revealed that discriminative ability of SDAI was better than that of DAS28. The optimal cut-off points for treatment changes were 4.46 for DAS28 (sensitivity 88%, specificity 87.5%) and 12.6 for SDAI (sensitivity 92%, specificity 83%).ConclusionSDAI is a valid tool for measurement of disease activity in RA in Indian population and is as good as DAS28 in its ability to assess the patient's status.     

High rate of improvement in serum matrix metalloproteinase-3 levels at 4 weeks predicts remission at 52 weeks in RA patients treated with adalimumab

Objective: This study aimed to determine whether serum matrix metalloproteinase-3 (MMP-3) levels can predict remission in rheumatoid arthritis (RA) patients treated with adalimumab (ADA).

Methods: Subjects were 114 RA patients continuously treated with ADA for 52 weeks. Predictive factors at baseline and 4 weeks after initiation of ADA therapy for the achievement of remission (28-point count Disease Activity Score-CRP (DAS28-CRP)?Results: DAS28-CRP at 4 weeks (odds ratio (OR) 0.614, 95% confidence interval (CI) 0.382–0.988) and improvement in serum MMP-3 levels at 4 weeks (OR 1.057, 95% CI 1.002–1.032) were independent predictors of remission at 52 weeks. The best cut-off level of DAS28-CRP and improvement in serum MMP-3 levels at 4 weeks for predicting remission at 52 weeks was 3.73 (sensitivity: 90%, specificity: 50%, area under the receiver operating characteristic curve (AUC): 62%) and 39.93% (sensitivity: 47%, specificity: 83%, AUC: 64%), respectively.

Conclusion: Our findings suggest that a high rate of improvement in serum MMP-3 levels at 4 weeks after initiation of ADA therapy can predict remission at 52 weeks in RA patients.     

Comparison of different definitions to classify remission and sustained remission: 1 year TEMPO results

OBJECTIVE: To assess methods to calculate achieving and sustaining remission in a double blind randomised trial in patients with RA who received etanercept, methotrexate, or an etanercept/methotrexate combination. METHODS: Remission was defined as DAS <1.6, DAS28 <2.6, and ACR70 response. Sustaining remission was analysed in three ways: (a) analysis of sustained DAS remission, DAS28 remission, or ACR70 response continuously for 6 months; (b) analysis of sustained remission appraised through a continuity rewarded scoring system, which is the weighted sum of all intervals in the study in which patients are in DAS or DAS28 remission; or (c) longitudinal modelling of remission odds using generalised estimating equations. RESULTS: Significantly more patients treated with the etanercept/methotrexate combination reached DAS remission (37%) than those treated with either methotrexate (14%) or etanercept (18%) alone (p<0.01). Results for DAS28 and for the ACR70 response were similar. Agreement between DAS remission and DAS28 remission was good, but agreement between either of these and the ACR70 response was less. Patients in DAS or DAS28 remission had a lower level of disease activity (fewer active joints, lower ESR) than those achieving ACR70 response; the converse was seen using pain VAS. The three methods were comparable for sustainability of remission and showed significant advantage for combination therapy, which increased the number and durability of remission periods. CONCLUSIONS: DAS and DAS28 remission results were similar for assessing achieving and sustaining remission in RA, frequently differing from patients classified as ACR70 responders. The three methods of examining duration of remission produced comparable results.     

Implementation of a treat‐to‐target strategy in very early rheumatoid arthritis: Results of the Dutch Rheumatoid Arthritis Monitoring remission induction cohort study

Objective

Clinical remission is the ultimate therapeutic goal in rheumatoid arthritis (RA). Although clinical trials have proven this to be a realistic goal, the concept of targeting at remission has not yet been implemented. The objective of this study was to develop, implement, and evaluate a treat‐to‐target strategy aimed at achieving remission in very early RA in daily clinical practice.

Methods

Five hundred thirty‐four patients with a clinical diagnosis of very early RA were included in the Dutch Rheumatoid Arthritis Monitoring remission induction cohort study. Treatment adjustments were based on the Disease Activity Score in 28 joints (DAS28), aiming at a DAS28 of <2.6 (methotrexate, followed by the addition of sulfasalazine, and exchange of sulfasalazine with biologic agents in case of persistent disease activity). The primary outcome was disease activity after 6 months and 12 months of followup, according to the DAS28, the European League Against Rheumatism (EULAR) response criteria, and the modified American College of Rheumatology (ACR) remission criteria. Secondary outcomes were time to first DAS28 remission and outcome of radiography.

Results

Six‐month and 12‐month followup data were available for 491 and 389 patients, respectively. At 6 months, 47.0% of patients achieved DAS28 remission, 57.6% had a good EULAR response, and 32.0% satisfied the ACR remission criteria. At 12 months, 58.1% of patients achieved DAS28 remission, 67.9% had a good EULAR response, and 46.4% achieved ACR remission. The median time to first remission was 25.3 weeks (interquartile range 13.0–52.0). The majority of patients did not have clinically relevant radiographic progression after 1 year.

Conclusion

The successful implementation of this treat‐to‐target strategy aiming at remission demonstrated that achieving remission in daily clinical practice is a realistic goal.

     

Remission occurs still only in minority of rheumatoid arthritis while a tight control is achievable in a routine clinical practice – A cross section study

The current recommended target is to achieve remission, if not at least low disease activity (LDA) in management of rheumatoid arthritis (RA). We analysed the incidence of patients achieving LDA or in remission in a real time clinical situation in a tertiary referral rheumatology centre, at a given point of time.Materials and methodsWe reviewed 480 patients who fulfilled classification criteria for RA and who were assessed for 28 Tender Joint Count (TJC), Swollen Joint Count (SJC), ESR and CRP. Their DAS28 (3) CRP and DAS28 (3) ESR score were calculated and were classified into LDA, remission, low, moderate and high disease activity based on the DAS28 (3) score.Results5.9% and 21.9% were in remission and 12% and 10% were in LDA based on DAS28 (3) ESR and DAS28 (3) CRP respectively. There was no significant influence of duration of illness, treatment and age in attaining both LDA and remission in our population.Conclusion5.9% and 21.9% of RA were in remission based on DAS28 (3) ESR and DAS28 (3) CRP respectively and 12% and 10% of RA patients were in LDA based on DAS28 (3) ESR and DAS28 (3) CRP respectively at the point of our study. DAS (3) CRP overestimate remission compared to DAS28 (3) ESR.     

Sustained remission and reduced radiographic progression with combination disease modifying antirheumatic drugs in early rheumatoid arthritis

OBJECTIVE: To study sustainability of remission and good treatment response, and the association of both with radiographic progression, in early rheumatoid arthritis (RA) in the Finnish Rheumatoid Arthritis Combination Therapy trial (FIN-RACo). METHODS: Patients were randomized to receive either a combination of disease modifying antirheumatic drugs (DMARD; COMBI, n = 97) or a single DMARD (SINGLE, n = 98). Remission was defined according to modified American College of Rheumatology (ACR) remission criteria and Disease Activity Score 28 joint count (DAS28) < or = 2.6, and sustained remission as presence of remission at 6, 12, and 24 months. Good treatment response was defined as DAS28 (3/4) 3.2 and decrease of DAS28 >1.2. RESULTS: In 169 patients with complete data, 33 (42%) COMBI and 18 (20%) SINGLE patients achieved modified ACR remission at 2 years, which was sustained in 11 (14%) COMBI and 3 (3%) SINGLE patients. Fifty-four (68%) COMBI and 37 (41%) SINGLE patients were in DAS28 remission at 2 years, which was sustained in 40 (51%) COMBI and 14 (16%) SINGLE patients. Good treatment response was sustained in 67% of COMBI and 27% of SINGLE patients. Over 2 years, the Larsen score increased by a median of 1 (95% CI 0-2) in patients in sustained DAS28 remission compared to 4 (95% CI 2-16) in patients who were in DAS28 remission at 6 months but lost it later; and by 6 (95% CI 2-10) in patients who were not in remission at 6 months. CONCLUSION: A remarkable proportion of patients with early RA treated with combinations of DMARD were in remission at 2 years, and remission was more often sustained compared to patients treated with a single DMARD. Sustained remission protects against radiographic joint damage.     

Efficacy and safety of tofacitinib in Japanese patients with rheumatoid arthritis by background methotrexate dose: A post hoc analysis of clinical trial data

Abstract

Objectives: Tofacitinib is an oral JAK inhibitor for the treatment of rheumatoid arthritis (RA). We investigated concomitant methotrexate (MTX) dose on tofacitinib efficacy/safety in Japanese RA patients.

Methods: This post hoc analysis pooled data from a 3-month phase 2 study (NCT00603512) and a 24-month phase 3 study (NCT00847613). Patients (N= 254) received tofacitinib (low-dose (1 or 3?mg), 5?mg, 10?mg) twice daily (BID) or placebo, with low-dose (>0 to 8?mg/week) or high-dose (>8?mg/week) MTX. Efficacy (ACR20/50/70 and DAS28-4 (ESR)<2.6 response rates; changes from baseline (CFB) in DAS28-4 (ESR) and HAQ-DI) and safety (adverse events (AEs), discontinuations due to AEs, serious AEs, and deaths) were assessed through month 3.

Results: At month 3, ACR20/50/70 response rates, mean DAS28-4 (ESR) CFB and HAQ-DI CFB were similar across MTX doses and generally greater for all tofacitinib doses versus placebo. AE rates with low-dose/high-dose MTX were: placebo, 28.6%/52.9%; tofacitinib low-dose, 50.0%/66.7%; 5?mg BID, 56.5%/64.3%; 10?mg BID, 73.8%/67.7%.

Conclusion: Tofacitinib efficacy in Japanese RA patients may be unaffected by background MTX dose. AE rates with low-dose versus high-dose MTX were lower with placebo, tofacitinib low-dose or 5?mg BID, but not 10?mg BID, with no apparent differences across system organ class/laboratory parameters.     

Comparative validation of clinical disease activity index (CDAI) and simplified disease activity index (SDAI) in rheumatoid arthritis in India

BackgroundCDAI and SDAI have been frequently used to categorize disease activity in patients with rheumatoid arthritis (RA), but have not been comparatively validated in Indian population.ObjectiveTo validate CDAI and SDAI in RA, taking DAS-28 as gold standard and to derive new cutoffs for CDAI and SDAI.MethodsPatients fulfilling ACR/EULAR criteria for diagnosis of RA were studied. After complete history, physical examination and biochemical tests, patients were grouped into remission, low, moderate and high activity on the basis of pre-defined cut-offs for DAS-28, CDAI, and SDAI. Spearman’s correlation and group wise inter-rater agreement tests were performed. Using DAS-28 as gold standard, the sensitivity and specificity of CDAI and SDAI cut off were determined for predicting levels of disease activity by area under receiver operator characteristics curves. (AUROC)ResultsWe studied 112 patients with RA, there was excellent correlation between DAS-28 and CDAI (r = 0.96 with 95% C.I. = 0.94?0.97), CDAI and SDAI (r=0.99, 95% C.I. 0.98?1), and DAS-28 and SDAI (r = 0.96, 95% C.I. = 0.94?0.97). There was a good inter-rater agreement between the various levels of disease activity as defined by DAS-28 and CDAI (weighed k = 0.598) and DAS-28 and SDAI (weighed k = 0.699) with excellent agreement between SDAI and CDAI categories (weighed k = 0.816). There was no statistically significant difference between AUROC of CDAI and SDAI and both performed equally well.ConclusionCDAI and SDAI are highly correlated with DAS-28 score hence are good markers of disease activity. The cut-off values for CDAI and SDAI used in western literature can be used with minor modifications in Indian scenario.     

Patient perspective on remission in rheumatoid arthritis: Validation of patient reported outcome instruments to measure absence of disease activity

ObjectivePatients have identified pain, fatigue and independence as the most important domains that need to be improved to define remission in rheumatoid arthritis (RA). This study identified and validated instruments for these domains and evaluated their added value to the ACR/EULAR Boolean remission definition.MethodsPatients with a 28-joint Disease Activity Score (DAS28) ≤3.2 or in self-perceived remission (declaring their disease activity ‘as good as gone’) from the Netherlands, Portugal, Australia, and Canada, were assessed at 0, 3 and 6 months for patient-reported outcomes and the WHO-ILAR RA core set. Instrument validity was evaluated cross-sectionally, longitudinally and for the ability to predict future good outcome in terms of physical functioning. Logistic regression quantified the added value to Boolean remission.ResultsOf 246 patients, 152 were also assessed at 3, and 142 at 6 months. Most instruments demonstrated construct validity and discriminative capacity. Pain and fatigue were best captured by a simple numerical rating scale (NRS). Measurement of independence proved more complex, but a newly developed independence NRS was preferred. NRS for pain, fatigue and independence, in addition to or instead of patient global assessment did not add enough information to justify modification of the current Boolean definition of remission in RA.ConclusionKey elements of the patient perspective on remission in RA can be captured by NRS pain, fatigue, and independence. Although this study did not find conclusive evidence to improve the current definition of remission in RA, the information from these instruments adds value to the physician's assessment of remission and further bridges the gap between physician and patient.     

Evaluation of the preliminary definitions of minimal disease activity and remission in an early seropositive rheumatoid arthritis cohort

OBJECTIVE: To evaluate published proposed definitions of minimal disease activity (MDA) and remission in patients with early rheumatoid arthritis (RA). METHODS: The cohort comprised disease-modifying antirheumatic drug (DMARD)-naive patients with early seropositive active RA (n = 200) treated with traditional DMARDs in the prebiologic era. MDA definitions included Disease Activity Score in 28 joints (DAS28) 相似文献   

Effect of baseline rheumatoid factor (RF) levels on DAS28-response to standard DMARD-combination treatment in patients with rheumatoid arthritis (RA)

ObjectiveRheumatoid factor (RF) positivity has been associated with an unfavourable outcome in rheumatoid arthritis (RA). Our study aimed to find a baseline RF cut-off level that would determine the response to standard disease modifying anti-rheumatic drug (DMARD) combination treatment.Patients and methodsWe studied 233 seropositive (RF levels ≥ 20 IU/mL at presentation) RA patients over a period of up to 5 years. Disease activity was assessed at each patient-encounter using disease activity score on 28 joints (DAS28). Treatment consisted of weekly methotrexate, daily hydroxychloroquine and low dose oral methlyprednisolone as an adjunct. Sulfasalazine or leflunomide were added to the ongoing regimen if satisfactory response was not achieved by 3 months of treatment. Individual response of patients to treatment was graded using the following DAS28 cut-off values: < 3 as low disease activity (satisfactory response), ≥ 3 as moderate and ≥ 5.1 as high (unsatisfactory response).ResultsBy analyzing all possible 2 × 2 contingency tables based on the different values of RF in the data set, using Fisher's exact test of association between RF levels and DAS28 values, a cut-off level for RF of 70 IU/mL gave the optimal discrimination between ‘low’ versus ‘moderate or high’ disease activity in the follow-up.ConclusionA baseline RF cut-off value of 70 IU/mL appears to predict a ‘satisfactory’ versus ‘unsatisfactory’ response to standard DMARD-combination therapy in RA over time.     

Remission and rheumatoid arthritis: data on patients receiving usual care in twenty-four countries

OBJECTIVE: To compare the performance of different definitions of remission in a large multinational cross-sectional cohort of patients with rheumatoid arthritis (RA). METHODS: The Questionnaires in Standard Monitoring of Patients with RA (QUEST-RA) database, which (as of January 2008) included 5,848 patients receiving usual care at 67 sites in 24 countries, was used for this study. Patients were clinically assessed by rheumatologists and completed a 4-page self-report questionnaire. The database was analyzed according to the following definitions of remission: American College of Rheumatology (ACR) definition, Disease Activity Score in 28 joints (DAS28), Clinical Disease Activity Index (CDAI), clinical remission assessed using 42 and 28 joints (Clin42 and Clin28), patient self-report Routine Assessment of Patient Index Data 3 (RAPID3), and physician report of no disease activity (MD remission). RESULTS: The overall remission rate was lowest using the ACR definition of remission (8.6%), followed by the Clin42 (10.6%), Clin28 (12.6%), CDAI (13.8%), MD remission (14.2%), and RAPID3 (14.3%); the rate of remission was highest when remission was defined using the DAS28 (19.6%). The difference between the highest and lowest remission rates was >/=15% in 10 countries, 5-14% in 7 countries, and <5% in 7 countries (the latter of which had generally low remission rates [<5.5%]). Regardless of the definition of remission, male sex, higher education, shorter disease duration, smaller number of comorbidities, and regular exercise were statistically significantly associated with remission. CONCLUSION: The use of different definitions of RA remission leads to different results with regard to remission rates, with considerable variation among countries and between sexes. Reported remission rates in clinical trials and clinical studies have to be interpreted in light of the definition of remission that has been used.     

The utility of 25-question Geriatric Locomotive Function Scale for evaluating functional ability and disease activity in Japanese rheumatoid arthritis patients: A cross-sectional study using NinJa database

Abstract

Objectives: To investigate the distribution of 25-question Geriatric Locomotive Function Scale (GLFS-25) scores in Japanese rheumatoid arthritis (RA) patients and evaluate relationships with clinical variables.

Methods: Among 15,115 patients registered in the NinJa database for fiscal year 2015, 1710 with complete GLFS-25 and disease activity score-28 (DAS28) data were analyzed. Correlations between GLFS-25 score and clinical variables were assessed by Spearman coefficients. Mean GLFS-25 scores were compared among DAS28 groups (<2.6, 2.6?3.1, 3.2?5.0, ≥5.1) using the Kruskal–Wallis test. To evaluate the performance of the GLFS-25 and Health Assessment Questionnaire Disability Index (HAQ-DI) for predicting DAS28?≥?3.2 (moderate/high disease activity), receiver operator characteristic (ROC) curves were constructed.

Results: GLFS-25 score was significantly correlated with age, disease duration, DAS28, and HAQ-DI. GLFS-25 score increased in parallel with DAS28. The proportion of patients with locomotive syndrome stage 2 also increased with DAS28. Area under the curve values for HAQ-DI and GLFS-25 score were 0.739 and 0.768, respectively. At a GLFS-25 positive cutoff score?≥16, sensitivity was 0.716 and specificity was 0.661 for predicting DAS28?≥?3.2.

Conclusion: This study documents the GLFS-25 score distribution in Japanese RA patients and demonstrates that GLFS-25 is a useful measure for evaluating functional ability in RA.     

Revising DAS28 scores for remission in rheumatoid arthritis

Current initiatives to treat rheumatoid arthritis (RA) to target remission have resulted in the widespread use of composite outcome measures to quantify disease activity. Simplified Disease Activity Index (SDAI) ≤3.3 is the gold standard of remission. Previous work has suggested that the remission threshold of DAS28-ESR or DAS28-CRP ≤2.6 is known to be not strict enough and should be revised. There is no previous study that looks at the equivalent DAS28-CRP value that best reflects SDAI remission in a real-life cohort. Consecutive cases fulfilling ACR/EULAR classification criteria for RA from one centre were included if they had an optimum number of visits with recording of all raw data to calculate DAS28-ESR, DAS28-CRP and SDAI. Data from seven visits each of 76 patients, providing 532 data points was examined. Spearman’s correlation between DAS28-ESR, DAS28-CRP and SDAI was 0.91–0.97 (p?<?0.001). A Bland-Altman plot demonstrated a mean difference of 0.37 units between DAS28-ESR and DAS28-CRP (p?<?0.001). ROC and kappa analysis provided values of 2.58 and 2.55 for DAS28-ESR4V and 2.09 and 2.05 for DAS28-CRP4V for SDAI value of 3.3, respectively. The two versions of DAS28 using ESR and CRP and SDAI correlate but are not equivalent or interchangeable for an individual patient. The DAS28-CRP overestimates remission and should be revised downwards to a proposed value of 2.1.     

Validation of RAPID3 using a Japanese version of Multidimensional Health Assessment Questionnaire with Japanese rheumatoid arthritis patients: Characteristics of RAPID3 compared to DAS28 and CDAI

Abstract

Objectives. To validate Routine Assessment of Patient Index Data 3 (RAPID3) using a Japanese version of Multidimensional Health Assessment Questionnaire (MDHAQ) with Japanese rheumatoid arthritis (RA) patients and to describe the characteristics of RAPID3 by comparison with Disease Activity Score 28 (DAS28) and Clinical Disease Activity Index (CDAI).

Methods. The original MDHAQ was translated into Japanese with minor cultural modifications and was translated back in English. Test–retest reliability was evaluated in 50 Japanese RA patients and further validation was performed in 350 Japanese RA patients recruited by seven rheumatologists. RAPID3, CDAI, and DAS28 were assessed on two consecutive visits.

Results. The test–retest reliability and the internal reliability of RAPID3 were excellent. Spearman's correlation coefficients between RAPID3 score versus CDAI score and DAS28 score were 0.761and 0.555. However, the agreement measured by kappa (weighted) for RAPID3 category versus CDAI category and for RAPID3 category versus DA28 category were 0.225 (0.382) and 0.187 (0.336). The sensitivity and specificity of “RAPID3 ≤ 3 and swollen joint ≤ 1” for predicting Boolean remission were 90.0% and 93.4%, respectively.

Conclusions. RAPID3 obtained by Japanese MDHAQ was validated with Japanese RA patients and the remission criteria were found to have excellent clinical utility in usual care.     

Prediction of DAS28-CRP remission in patients with rheumatoid arthritis treated with tacrolimus at 6 months by baseline variables

Abstract

We attempted to determine what baseline variables are responsible for the efficacy of tacrolimus at 6 months in Japanese patients with rheumatoid arthritis (RA). One hundred and six RA patients treated with tacrolimus for 6 months were entered in this study. The outcome was set as the achievement of Disease Activity Score 28 C-reactive protein (DAS28-CRP) remission at 6 months. We examined the association of gender, DAS28-CRP at baseline, concomitant use of methotrexate (MTX), and concomitant use of prednisolone with the achievement of DAS28-CRP remission at 6 months by logistic regression analysis. Twenty-three of 106 patients (21.7%) achieved DAS28-CRP remission at 6 months. There was concomitant use of MTX by 20 patients (18.9%), prednisolone by 93 (87.7%), and prednisolone >5 mg/day by 43 (40.6%) at baseline. Logistic regression analysis showed that male gender (first) and moderate disease activity at baseline (second) are independent predictors toward achieving DAS28-CRP remission at 6 months. Maximum tacrolimus dosage administrated for patients over a 6-month period appeared not to be predictive for the DAS28-CRP remission at 6 months. In conclusion, we revealed for the first time that good outcome in RA patients treated with tacrolimus can be predictive by some baseline variables. That is clinically valuable for daily practice in the choice of disease-modifying antirheumatic drugs (DMARDs), especially tacrolimus.     

Review of rheumatoid arthritis disease outcome measures: Recommendations and its relevance in private practice

The ultimate goal of pharmacological treatment in Rheumatoid Arthritis (RA) is to reach and sustain remission, prevent functional disability and organ damage. Recent improvements and insights in RA treatment such as availability of wider range of disease modifying agents including biological agents have made ‘clinical remission’ a realistic target for many patients. To optimise RA treatment physicians must monitor the disease activity accurately to adjust treatment according to disease activity levels. In RA, several disease outcomes such as painful and swollen joints, functional impairment and acute phase reactants are recognized as manifestations of underlying disease process. To monitor the disease accurately, an index expressing these outcomes as a single continuous variable is required. The widely used disease outcome measures in clinical trials are the American College of Rheumatology (ACR) recommended indices: DAS28 (ESR or CRP), PAS, PAS-II, RAPID-3, SDAI and CDAI which have different relevance in clinical practice as compared to clinical trials. DAS28 hitherto considered gold standard in measuring RA outcomes in clinical trials may not hold appeal in clinical practice because of complexities associated with its calculations and waiting time due to inclusion of laboratory measurements. In recent times, simpler scores such as RAPID-3 and CDAI are being evaluated in global and Indian studies as a preferred outcome measure in point-of-care clinical setting because of their simplicity and ease of administration especially in a fund-stricken country like India.     

2-D speckle-tracking assessment of left and right ventricular function in rheumatoid arthritis patients with and without disease activity

Objectives

Disease activity has been considered as independent cardiovascular risk factor in rheumatoid arthritis (RA) patients. We aimed to evaluate the effect of RA disease activity on left ventricular (LV) and right ventricular (RV) functions by speckle tracking echocardiography (STE).