Performance of Routine Assessment of Patient Index Data 3 (RAPID3) for assessment of rheumatoid arthritis in clinical practice: differential agreement of RAPID3 according to disease activity categories

To evaluate the performance of Routine Assessment of Patient Index Data 3 (RAPID3) with the disease activity score 28 (DAS28) and the clinical/simplified disease activity index (CDAI/SDAI) in a Korean population with rheumatoid arthritis (RA). Four hundred patients with RA were consecutively enrolled. All patients completed disease activity indices such as RAPID3, DAS28, SDAI, and CDAI. The kappa and/or weighted coefficients were used to assess agreement between RAPID3 and other disease activity indices. ANOVA, Mantel–Haenszel chi-square test, and Spearman’s partial correlation analysis were used for analyses. RAPID3 scores were significantly correlated with DAS28 (r = 0.62), SDAI (r = 0.74), and CDAI (r = 0.75; p < 0.0001 for all indices) and other activity measures including swollen/tender joint counts, erythrocyte sediment rate, and C-reactive protein. The weighted kappa coefficients of RAPID3 with DAS28, SDAI, and CDAI among the four disease activity categories were 0.33, 0.34, and 0.33, respectively. Kappa coefficients for RAPID3 in two disease activity categories increased more than four categories (κ = 0.40–0.42) indicating fair agreement. More than 86 % of patients with high-to-moderate disease activity in DAS28, CDAI, and SDAI had high-to-moderate disease activity using RAPID3 criteria. However, approximately 50 % of patients with remission-to-low disease activity in DAS28, CDAI, and SDAI showed remission-to-low disease activity in RAPID3. This study confirms RAPID3 as an informative disease activity index with equivalent values in DAS28, CDAI, and SDAI. RAPID3 reveals differential agreement in patients with lower disease activity.     

Assessment of the validity of the 28-joint disease activity score using erythrocyte sedimentation rate (DAS28-ESR) as a disease activity index of rheumatoid arthritis in the efficacy evaluation of 24-week treatment with tocilizumab: subanalysis of the SATORI study

Abstract

As tocilizumab (TCZ) greatly inhibits inflammatory markers, methods of evaluating rheumatoid arthritis (RA) disease activity that include inflammatory markers may overestimate the effect of TCZ treatment. We have evaluated the impact of inflammatory markers on the efficacy of TCZ by comparing the efficacy indicated by the 28-joint disease activity score using erythrocyte sedimentation rate (DAS28-ESR) with that indicated by the clinical and simplified disease activity indexes (CDAI and SDAI, respectively) and the American College of Rheumatology (ACR) core set criteria in a double-blind study of TCZ—the SATORI study. The Spearman correlation coefficient between DAS28-ESR and CDAI was comparable between that at week 24 and that at baseline [correlation coefficient at baseline and week 24 was 0.823 (p < 0.0001) and 0.818 (p < 0.0001), respectively]. A large difference between the DAS28 remission rate and CDAI remission rate was observed at week 24. However, these results are comparable to those of a previous study conducted with non-TCZ-treated patients. Moreover, the same results were obtained in the comparison between the DAS28-ESR and SDAI, even though the SDAI includes an inflammatory parameter as a component. These results confirm that the DAS28-ESR has a validity comparable to that of other methods in terms of evaluating the RA treatment efficacy of TCZ, despite its strong inflammatory marker-inhibiting effects.     

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.     

Comparison of composite disease activity indices for rheumatoid arthritis

To evaluate the composite disease activity indices for rheumatoid arthritis (RA), we compared disease activities and the changes therein calculated using the Disease Activity Score based on 28 joint counts using erythrocyte sedimentation rate (DAS28-ESR), DAS28-CRP (C-reactive protein), Simplified Disease Activity Index (SDAI), and Clinical Disease Activity Index (CDAI) in a cohort of 1,412 patients with RA. The median (1st; 3rd quartile) scores were 4.20 (3.31; 5.14) for DAS28-ESR, 3.44 (2.59; 4.36) for DAS28-CRP, 13.6 (7.49; 21.1) for SDAI, and 12.0 (6.9; 18.9) for CDAI. Absolute scores and their changes were significantly correlated (p < 0.0001) in all combinations among these four disease activity indices; however, their correlations were lower in males than in females. Correlations between disease activity indices and the clinical and acute phase reactant variables were different according to disease activity index, sex and age. A comparison of the number of patients in each disease activity category according to the disease activity indices using kappa-statistics revealed an almost perfect agreement between SDAI and CDAI (κ = 0.871), a moderate agreement between DAS28-ESR and SDAI (κ = 0.415) or CDAI (κ = 0.427), but only fair agreement between DAS28-ESR and DAS28-CRP (κ = 0.329). For the selection of a disease activity index for an evaluation of RA patients, both the convenience and the characteristics of the respective disease activity index should be considered.     

Prevalence of metabolic syndrome in rheumatoid arthritis patients from Northeastern Brazil: Association with disease activity

Objectives: To determine the prevalence of metabolic syndrome (MetS) in patients with rheumatoid arthritis (RA) and controls from Northeastern Brazil and to verify its association with specific RA parameters and cardiovascular risk factors.

Methods: The prevalence of MetS was assessed cross-sectionally in 338 RA patients from a single center and 84 age and gender-matched controls from the local community. MetS was defined according to NCEP/ATPIII guidelines. Disease activity was assessed with CDAI, SDAI and DAS28 scores. Independent risk factors for MetS in RA patients were identified by multivariate logistic regression.

Results: The prevalence of MetS was higher in RA patients than in controls (51.3% vs. 21.8%; p?p?p?=?.016) as independent risk factors for MetS in patients with RA.

Conclusion: RA in patients from Northeastern Brazil was found to be associated with increased WC, high prevalence of MetS (one of the highest in the world) and disease activity. Patients with MetS displayed a higher frequency of cardiovascular risk factors, indicating the need for better control of disease activity and modifiable risk factors for cardiovascular disease (CVD).     

Evaluation of disease activity indices in Korean patients with rheumatoid arthritis

The aim of this study is to examine the validity of the rheumatoid arthritis (RA), disease activity score (DAS), 28-C-reactive protein (CRP), the simplified disease activity index (SDAI), and the clinical disease activity index (CDAI) against the DAS28-erythrocyte sedimentation rate (ESR) and determine cut-off values for each tool in Korean patients with RA. A total of 223 RA patients were consecutively recruited from the Hanyang University Hospital for Rheumatic Diseases in Seoul, Korea. DAS28-CRP, SDAI, and CDAI were measured and compared with DAS28-ESR. The correlation coefficients of DAS28-ESR with DAS28-CRP, SDAI, and CDAI were 0.93, 0.85, and 0.84, demonstrating strong linear relationships. The cut-off values of DAS28-CRP classifying RA patients into four categories of disease activity were defined as 2.19, 2.60, and 4.07. SDAI cut-off values were defined as 3.75, 7.50, and 16.88. CDAI cut-off values were defined as 3.62, 7.38, and 16.50. DAS28-CRP, SDAI, and CDAI are valid and sensitive assessment indices of disease activity that are comparable to DAS28-ESR. The cut-off values of each tool derived in this study might be useful for routine monitoring and therapeutic decision-making in Korean RA patients.     

Serum amyloid a level and musculoskeletal ultrasound in assessment of disease activity in rheumatoid arthritis patients

Aim of the workTo assess serum amyloid A (SAA) level and study its relation to musculoskeletal ultrasound (MSUS) findings and to clinical disease activity indices in rheumatoid arthritis (RA) patients.Patients and methods60 RA patients and 60 matched controls were enrolled. Disease activity score-C-reactive protein (DAS-28-CRP) and simplified disease activity index (SDAI) and clinical disease activity Index (CDAI) were determined. MSUS evaluation was done using 12 -joint power Doppler ultrasound (PDUS) score. SAA was analyzed using an enzyme-linked immunosorbent assay.ResultsSAA levels were highly significant in patients (35.1 ± 3.6 mg/l) than in controls (1.6 ± 0.12 mg/l)(p < 0.001). There was significantly higher SAA level among steroid users (56.7 %)(p = 0.001) and a lower level among leflunomide users (30 %)(p = 0.04). SAA and PDUS significantly increased in patients with low disease activity (n = 13) compared to those in remission (n = 10)(p < 0.001). SAA significantly correlated with disease duration (p = 0.004), morning stiffness duration, swollen joint count, tender joint count, rheumatoid factor, anti-cyclic citrullinated peptide, DAS-28-CRP, SDAI, CDAI, erythrocyte sedimentation rate, CRP and total 12-joint PDUS score (p < 0.001). The highest discriminatory ability of active RA and remission was attributed to the combination of SAA, PDUS and CRP (accuracy = 96.7 %, AUC = 0.99; sensitivity 96 % and specificity 100 %).ConclusionRA patients have a significantly increased level of SAA which indicates a key pathogenic role in the disease. SAA level is a potentially effective biomarker in the assessment of disease activity in RAand allied to PDUS. Combining SAA, PDUS and CRP provide the highest sensitivity and specificity in discrimination of active RA from remission.     

Assessment of the validity of the 28-joint disease activity score using erythrocyte sedimentation rate (DAS28-ESR) as a disease activity index of rheumatoid arthritis in the efficacy evaluation of 24-week treatment with tocilizumab: subanalysis of the SATORI study

As tocilizumab (TCZ) greatly inhibits inflammatory markers, methods of evaluating rheumatoid arthritis (RA) disease activity that include inflammatory markers may overestimate the effect of TCZ treatment. We have evaluated the impact of inflammatory markers on the efficacy of TCZ by comparing the efficacy indicated by the 28-joint disease activity score using erythrocyte sedimentation rate (DAS28-ESR) with that indicated by the clinical and simplified disease activity indexes (CDAI and SDAI, respectively) and the American College of Rheumatology (ACR) core set criteria in a double-blind study of TCZ—the SATORI study. The Spearman correlation coefficient between DAS28-ESR and CDAI was comparable between that at week 24 and that at baseline [correlation coefficient at baseline and week 24 was 0.823 (p < 0.0001) and 0.818 (p < 0.0001), respectively]. A large difference between the DAS28 remission rate and CDAI remission rate was observed at week 24. However, these results are comparable to those of a previous study conducted with non-TCZ-treated patients. Moreover, the same results were obtained in the comparison between the DAS28-ESR and SDAI, even though the SDAI includes an inflammatory parameter as a component. These results confirm that the DAS28-ESR has a validity comparable to that of other methods in terms of evaluating the RA treatment efficacy of TCZ, despite its strong inflammatory marker-inhibiting effects.     

The role of musculoskeletal ultrasound in assessment of disease activity in rheumatoid arthritis patients with fibromyalgia

IntroductionFibromyalgia (FM) is frequently present in rheumatoid arthritis (RA) patients and this can lead to an overestimation of disease activity and consequently overtreatment. Musculoskeletal ultrasound (MSUS) can aid in evaluating synovitis for assessment of disease activity with more precision.Aim of the workTo verify the potential role of MSUS in the assessment of disease activity in RA patients with and without FM.Patients and methodsThis study was conducted on 100 active RA patients. Disease activity score (DAS28) and clinical disease activity index (CDAI) were assessed. MSUS was assessed using the 12 joint simplified score.ResultsThe 100 patients were 88 females and 12 male (F:M 7.3:1) with a mean age of 44.82 ± 11.4 years and disease duration of 6.88 ± 5.77 years. 67 RA patients had associated secondary FM and 33 did not. DAS-28 and CDAI were significantly higher in those with FM (4.99 ± 0.82 and 30.49 ± 10.59) compared to those without (4.22 ± 0.96 and 18 ± 10.68)(p < 0.001). Regarding ultrasonographic finding, no significant difference was found between those with and without FMS. DAS28 and CDAI significantly correlated (p = 0.006, p = 0.002 respectively) with grey scale ultrasound (GS-US12) in patients without FMS while DAS28 only significantly correlated with GS-US12 in those with FMS (r = 0.28, p = 0.022).ConclusionSecondary FM is common in RA patients and associated with a higher disease activity making it a potential influencer on the treatment strategy. MSUS can complement physical examination in the assessment of disease activity but had a limited role to delineate RA patients with FM from those without.     

Gastroesophageal reflux disease in patients with rheumatoid arthritis

Abstract

Objective. Patients with rheumatoid arthritis (RA) are frequently complicated with gastric mucosal injury; however, there are few reports investigating gastroesophageal reflux disease (GERD) among patients with RA. We investigated the frequency of GERD and the correlation between GERD and the clinical characteristics of RA including patient's global assessment (PGA).

Methods. Patients with RA were investigated for GERD using self-administered frequency scale for the symptoms of GERD (FSSG). The correlation between GERD and the clinical characteristics of RA was analyzed statistically.

Results. Two hundred and eleven patients in Japan were investigated. The prevalence of GERD among patients with RA (24.6%) was significantly higher than that in the Japanese population (11.5%) (p < 0.001). FSSG was positively correlated with modified health assessment questionnaire (mHAQ), PGA, evaluator's global assessment (EGA) (p < 0.001), disease activity score (DAS)28-erythrocyte sedimentation rate (ESR) (p < 0.05), DAS28-C-reactive protein (CRP), simplified disease activity index (SDAI) and clinical disease activity index (CDAI) (p < 0.001). The patients with GERD showed significantly higher scores in mHAQ, PGA, EGA, tenderness joint count, DAS28-ESR, DAS28-CRP, SDAI and CDAI (p < 0.001). Furthermore, the patients with GERD showed lower remission rates based on DAS28-ESR (p < 0.05), DAS28-CRP, SDAI and CDAI (p < 0.001).

Conclusion. GERD complicated with RA increases PGA and the indices of disease activity. GERD symptoms analyzed using FSSG may be desirable to avoid the overestimation as part of the total management of patients with RA.     

Perception of improvement in patients with rheumatoid arthritis varies with disease activity levels at baseline

Objective

To analyze the minimum clinically important improvement (MCII) of disease activity measures in rheumatoid arthritis (RA) using patient‐derived anchors, and to assess whether criteria for improvement differ with baseline disease activity.

Methods

We used data from a Norwegian observational database comprising 1,050 patients (73% women, 65% rheumatoid factor‐positive, mean duration of RA 7.7 years). At 3 months after initiation of therapy, patients indicated whether their condition had improved, had considerably improved, was unchanged, had worsened, or had considerably worsened. We used receiver operating characteristic curve analysis to determine the MCII for the Disease Activity Score based on the assessment of 28 joints (DAS28), the Simplified Disease Activity Index (SDAI), and the Clinical Disease Activity Index (CDAI), and analyzed the effects of different levels of baseline disease activity on the MCII.

Results

On average, patients started with high disease activity and improved significantly during treatment (American College of Rheumatology 20%, 50%, and 70% improvement criteria responses were 37%, 17%, and 5%, respectively). The overall mean (95% confidence interval [95% CI]) thresholds for MCII after 3 months for the DAS28, SDAI, and CDAI were 1.20 (95% CI 1.18–1.22), 10.95 (95% CI 10.69–11.20), and 10.76 (95% CI 10.49–11.04), respectively, and the mean (95% CI) thresholds for major responses were 1.82 (95% CI 1.80–1.83), 15.82 (95% CI 15.65–16.00), and 15.00 (95% CI 14.82–15.18), respectively. With increasing disease activity, much higher changes in disease activity were needed to achieve MCII according to patient judgment.

Conclusion

The perception of improvement of disease activity of patients with RA is considerably different depending on the disease activity level at which they start.     

Interleukin‐6 receptor inhibition with tocilizumab and attainment of disease remission in rheumatoid arthritis: The role of acute‐phase reactants

Objective

To determine the effects of tocilizumab on rheumatoid arthritis (RA) disease activity and remission assessment, using measures that do or do not comprise acute‐phase reactants.

Methods

Simplified Disease Activity Index (SDAI) scores, Clinical Disease Activity Index (CDAI) scores, and the Disease Activity Score in 28 joints (DAS28) were calculated using data from tocilizumab trials in patients with RA in whom disease had remained active despite treatment with disease‐modifying antirheumatic drugs. The CDAI does not contain an acute‐phase reactant component. Disease activity states, including remission, were defined using established cut points; for the DAS28, an alternative cut point of <2.4 was also used.

Results

Changes in the DAS28, the SDAI score, and the CDAI score among patients receiving tocilizumab were significantly higher than those among patients receiving placebo, and the magnitude of these changes was similar for the SDAI and the CDAI. Among patients who achieved 50% improvement in disease activity according to the American College of Rheumatology criteria, only ∼20% required a reduction in acute‐phase reactant values in order to fulfill the criteria. However, DAS28 remission rates were higher (even when using the lower cut point) than the SDAI and CDAI remission rates. Only a minority of tocilizumab‐treated patients with DAS28 remission also had disease remission according to the SDAI (26%) or CDAI (∼21%). With infliximab treatment, SDAI and CDAI remission rates were of the same magnitude as those observed with tocilizumab treatment, and DAS28 remission rates were lower. Tocilizumab‐treated patients with DAS28 remission but without CDAI remission had significantly higher swollen joint counts but lower erythrocyte sedimentation rates (ESRs) compared with patients with SDAI or CDAI remission.

Conclusion

Disease activity in RA is reduced by tocilizumab treatment, irrespective of the type of composite measure used to evaluate disease activity. Remission rates were much higher using the DAS28 compared with the SDAI and CDAI, due to the high weight of the ESR in the DAS28 and the effect of tocilizumab on the ESR. Using the stringent SDAI and CDAI criteria, however, remission rates in patients treated with tocilizumab were in the same range as those seen in patients treated with tumor necrosis factor inhibitors.

     

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.     

Reexamination of the assessment criteria for rheumatoid arthritis disease activity based on comparison of the Disease Activity Score 28 with other simpler assessment methods

Objective

To explore simpler and possibly more appropriate tools than the conventional Disease Activity Score 28 (DAS28) for assessing rheumatoid arthritis (RA) and to derive more reliable DAS28-based criteria.

Methods

The capabilities of assessing disease activities in 250 RA patients were compared between DAS28 and other methods, including the Simplified DA Index (SDAI), Clinical DA Index (CDAI), and Routine Assessment of Patient Index Data-3 (RAPID-3).

Results

SDAI and CDAI showed a good correlation and consistency with DAS28, whereas RAPID-3 yielded inferior results. In terms of remission criteria, DAS28 was less stringent than SDAI or CDAI; when RA remission was reexamined based on more stringent SDAI or CDAI criteria, cut-off values for DAS28-C-reactive protein of <1.72 were considered to be appropriate. The conventional DAS28 was considered to be appropriate for assessing low, middle and high disease activities because it provides criteria similar to or more stringent than those of other methods, while SDAI and CDAI were considered to be simpler and more appropriate criteria for assessing remission.

Conclusion

For assessing remission, DAS28-CRP provides the most appropriate criterion of the methods compared when the currently used cut-off value of 2.3 is lowered to a new value of 1.72.     

Comparison between different disease activity scores in rheumatoid arthritis: an Egyptian multicenter study

The aim of our work was to assess the performance of different Disease Activity Score (DAS) other than DAS-ESR in daily clinical practice in our Egyptian outpatient clinics and also to evaluate the accuracy of European League Against Rheumatism Classification (EULAR) proposed cutoffs for these scores to stratify Egyptian patients into different categories of disease activity. This study is a cross-sectional Egyptian multicenter study. It included 130 rheumatoid arthritis (RA) patients who visited our Rheumatology and Rehabilitation outpatient and inpatient clinics; 80 patients from Cairo University Hospitals and 50 patients from Zagazig University Hospitals. The patients fulfilled the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism Classification criteria for rheumatoid arthritis. Disease Activity Score 28-ESR (DAS28-ESR), DAS28-CRP, Simplified Disease Activity Index (SDAI), and Clinical Disease Activity Index (CDAI) were calculated. A significant positive correlation was found between all three scores and morning stiffness, ESR, Modified Health Assessment Questionnaire (MHAQ), and DAS-ESR. Also, there was a significant negative correlation between DAS-CRP and hemoglobin and a significant positive correlation with CRP. Also, there was a highly significant moderate agreement between DAS-ESR and DAS-CRP using Fleischmann et al. thresholds and also between DAS-ESR and SDAI. While a highly significant fair agreement was found between DAS-ESR and DAS-CRP using DAS-ESR thresholds and between DAS-ESR and CDAI. We conclude that DAS-CRP, SDAI, and CDAI are very useful in representing disease activity in RA patients in our outpatient clinics being well correlated with many markers of disease activity. We recommend huge multicenter studies in Egypt and in different populations to define new cutoff values to optimize their use in clinical setting.     

Relation of some clinical composite indices of disease activity in rheumatoid arthritis to a simplified 12 joint power Doppler ultrasound activity index

Aim of the workTo assess the association of some clinical composite disease activity indices with a simplified 12 joint power Doppler ultrasound (PDUS) activity index in rheumatoid arthritis (RA).Patients and methodsOne hundred RA patients who fulfilled the 2010 European league against rheumatism/American college of Rheumatology (EULAR/ACR) classification criteria for RA were recruited from the Rheumatology outpatient clinic, Cairo University Hospitals. Disease activity score (DAS28), the simplified disease activity index (SDAI), clinical disease activity index (CDAI) as well as mean overall index for RA (MOI-RA) were assessed. Grey Scale Ultrasonography (GSUS) and PDUS activity assessment was performed using a simplified 12-joint score.ResultsThe 100 patients were 80 females and 20 males (F:M 4:1). Their mean age was 44.4 ± 10.8 years with disease duration of 6.3 ± 4.7 years. Rheumatoid factor was positive in 77 %. DAS28 was 4.5 ± 1.3, SDAI 27.7 ± 22.7, CDAI 17.5 ± 13.2 and MOI-RA 86.8 ± 25.1. On US, tenosynovitis was present in 10 %, irregularity in 23 % and erosion in 62 %. The mean 12-point PDUS was 3.53 ± 4.16 and the overall US score 10.34 ± 9.3. A significant correlation was found between the US findings of overall synovitis, degree of PD and US score with DAS28 (r = 0.3, p < 0.0001; r = 0.4, p < 0.0001 and r = 0.3, p < 0.0001) with SDAI (r = 0.3, p < 0.0001; r = 0.4,p < 0.0001; r = 0.4, p < 0.0001) and with MOI-RA score (r = 0.3, p < 0.0001; r = 0.4, p < 0.0001 and r = 0.4, p < 0.0001 respectively) but the highest correlations was with CDAI (r = 0.4, p < 0.0001; r = 0.5, p < 0.0001 and r = 0.4, p < 0.0001 respectively).ConclusionSimplified 12 -joint PDUS score is well correlated with activity indices in RA patients.     

Achieving simplified disease activity index remission in patients with active rheumatoid arthritis is associated with subsequent good functional and structural outcomes in a real-world clinical setting under a treat-to-target strategy

Objective: To verify predictive validity of simplified disease activity index (SDAI) remission for subsequent functional and structural outcomes in real-world clinical settings under a treat-to-target strategy (T2T).

Methods: In this multicenter, prospective cohort study, T2T was implemented in rheumatoid arthritis (RA) patients with moderate-to-high disease activity. SDAI or clinical disease activity index (CDAI) was assessed every 12 weeks, and treatment was adjusted to achieve clinical remission or low disease activity (LDA). Multivariate logistic regression models were used to examine the associations of SDAI remission (≤3.3) at week 24 with the health assessment questionnaire-disability index (HAQ-DI)?≤?0.5 or with the delta van der Heijde-modified total Sharp score (ΔvdH-mTSS)?Results: Of 318 patients enrolled, 271 completed the follow-up for 72 weeks and were subjects of the analyses. Factors [odds ratio (95% confidence interval)] significantly associated with the HAQ-DI ≤0.5 were SDAI remission at week 24 [2.99 (1.42–6.28), p?=?0.004], baseline HAQ-DI [0.28 (0.18–0.45), p?=?1.3?×?10^?7], and baseline vdH-mTSS [0.986 (0.976–0.996), p?=?0.009]. A factor associated with ΔvdH-mTSS?p?=?0.002].

Conclusion: Predictive validity of SDAI remission for good outcomes was verified in a T2T-implementing cohort in the current clinical settings.     

The reliability and validity of the Turkish version of Fullerton Advanced Balance (FAB-T) scale

PurposeThe aim of this study was to evaluate the reliability and validity of the Turkish version of the FAB(FAB-T) scale in the older Turkish adults.MethodsThe reliability and validity of the scale was tested on 200 community-dwelling older adults. FAB-T scale was scored by different physiotherapists on different days to evaluate inter-rater and intrarater reliability. The Berg Balance Scale (BBS) was used for the evaluation of convergent validity, and the content validity of the FAB-T scale was investigated.ResultsThe FAB-T scale showed very high inter- and intra-rater reliability. For inter-rater agreement, on the individual test items and total score ICC values were 0.92 (95 %CI; 0.90–0.94) and 0.96 (95% CI; 0.95–0.97) respectively. The intra-rater agreement, on the individual test items and total score ICC values were 0.93 (95 %CI; 0.91– 0.95) and 0.96 (95% CI; 0.95– 0.97) respectively. There was a good agreement between the FAB-T and BBS scales. A high correlation was found between the BBS and FAB-T scales [rho = 0.70 (%95 CI; 0.62–0.76)] indicating good convergent validity. Considering the content validity of the FAB-T scale, no floor (floor score: 0%) or ceiling (ceiling score: 6.5%) effect was detected.Conclusion: The FAB-T scale was successfully translated from the original English version (FAB) and demonstrated strong psychometric features. It was found that the FAB-T scale has very high inter-rater and intra-rater reliability. Considering the convergent validity, the scale has high correlation with the BBS. The FAB-T has no floor and ceiling effect.     

The relationship between bristol rheumatoid arthritis fatigue scales and disease activity of patients with rheumatoid arthritis

Fatigue is a symptom that affects the 40–80% of patients with rheumatoid arthritis (RA) and impairs the quality of life. The aim of this study was to assess multidimensional fatigue scales, the Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ) and the Bristol Rheumatoid Arthritis Fatigue Numerical Rating Scale (BRAF-NRS) and to evaluate their relationship with disease activity in Turkish RA patients. The study included 180 patients with RA. The Disease Activity Score (DAS28), Clinical Disease Activity Index (CDAI), and Simplified Disease Activity Index (SDAI) were used to evaluate disease activity. The participants comprised of 142 females and 38 males. The mean ± standard deviations of DAS28, CDAI, and SDAI were 3?±?1.24, 9.51?±?7.96, and 10.5?±?8.38 respectively. All scales except the emotional subscale were correlated with disease activity. The emotional subscale correlated with CDAI and SDAI but not with DAS28. The results of the study indicated that fatigue and disease activity were correlated. Fatigue is a symptom that impairs the quality of life but it can be easily coped with by controlling disease activity. Thus, it should be assessed in a multidimensional perspective.     

Remission and active disease in rheumatoid arthritis: defining criteria for disease activity states

OBJECTIVE: Several composite scores are available to assess the activity of rheumatoid arthritis (RA). Criteria for remission and active RA based on these continuous scores are important for use in clinical practice and clinical trials. We aimed to reevaluate or to define such criteria for the Disease Activity Score in 28 joints (DAS28) and the Simplified Disease Activity Index (SDAI). METHODS: We sampled patient profiles from an observational RA database that included clinical and laboratory variables. Thirty-five rheumatology experts classified these profiles into 1 of 4 categories: remission, low, moderate, or high disease activity. Cutoff values were estimated by mapping scores on the DAS28 and SDAI to these ratings, and analyses of agreement (kappa statistics) and a diagnostic testing approach (receiver operating characteristic curves) were used to validate the estimates. The final criteria were validated using 2 observational cohorts (a routine cohort of 767 patients and an inception cohort of 91 patients). RESULTS: Results from the 3 analyses were very similar and were integrated. The criteria for separating remission, low, moderate, and high disease activity based on the SDAI were scores of 3.3, 11, and 26, respectively; those based on the DAS28 were scores of 2.4, 3.6, 5.5, respectively. In the routine cohort, these cutoff values showed substantial agreement (weighed kappa = 0.70) and discriminated between groups of patients with clearly different functional capacities (P < 0.001). In the inception cohort, these cutoff scores differentiated responders (those with a 20% response on the American College of Rheumatology improvement criteria) from nonresponders (P < 0.01), as well as patients with and without radiologic progression (P < 0.05). CONCLUSION: New criteria for levels of RA disease activity were determined and internally validated. These criteria, which are based on current and explicit expert judgment, are valuable in this era of rapidly advancing therapeutic approaches.