Disease Activity Score 28 (DAS28) using C-reactive protein underestimates disease activity and overestimates EULAR response criteria compared with DAS28 using erythrocyte sedimentation rate in a large observational cohort of rheumatoid arthritis patients in Japan (original) (raw)
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Annals of the Rheumatic Diseases, 2009
Objective: To validate and compare the definition of the Disease Activity Score 28 based on C-reactive protein (DAS28 (CRP)) to the definition based on erythrocyte sedimentation rate (ESR). Methods: Data were analysed from two randomised, double-blind, placebo-controlled trials of abatacept of 6month and 12-month duration in patients with rheumatoid arthritis. European League Against Rheumatism (EULAR) response criteria and the proportion of patients in remission (DAS28 ,2.6) based on the two DAS28 definitions were examined. Trends in radiographic progression (erosion score, joint space narrowing score and total score) and physical function (Health Assessment Questionnaire Disability Index (HAQ-DI)) across the EULAR responder states (none, moderate and good) were analysed. Results: There was general agreement in determining the EULAR responder state using both DAS28 definitions (k = 0.80, 95% CI 0.76 to 0.83). Overall, there was 82.4% agreement on the EULAR response criteria; when disagreements occurred, the DAS28 (CRP) yielded a better EULAR response more often then DAS28 (ESR) (12.6% vs 4.9%, respectively). There was also agreement in determining remission: k = 0.69 (95% CI 0.60 to 0.78). Radiographic progression decreased in patients treated with abatacept across EULAR states (from none to moderate to good) based on both definitions. For patients treated with placebo, the trend was not as pronounced, with radiographic scores higher for moderate vs nonresponders. For physical function, similar trends were observed across the EULAR states for both DAS28 definitions. Conclusions: The DAS28 (CRP) has been validated against radiographic progression and physical function. While the DAS28 (CRP) yielded a better EULAR response more often than the DAS28 (ESR), the validation profile was similar to the DAS28 (ESR), indicating that both measures are useful for assessing disease activity in patients with rheumatoid arthritis.
International Journal Of Community Medicine And Public Health, 2022
Background: Rheumatoid arthritis is a systemic and chronic disease. Combined indicators, such as disease activity score or DAS-28, can be used to categorize quantitative disease activity status and recovery. But in this calculation there is no difference between using ESR or CRP. Some studies have showed that using CRP instead of ESR will cause the severity of the disease to be underestimated. The aim of this study was to comparison of DAS-28 ESR and DAS-28 CRP in determining the severity of disease activity in patients with rheumatoid arthritis.Methods: This study was a cross-sectional and descriptive-analytical study on patients with rheumatoid arthritis who referred to the rheumatology clinic of Imam Khomeini Hospital. 200 patients from the target community who referred to the rheumatology clinic were randomly selected and studied. Relevant questionnaires including demographic information such as age, sex, cigar consumption were completed from the study.Results: In this study, 20...
Comparative study of DAS 28 ESR and DAS 28 CRP among rheumatoid arthritis patients in India
Indian Journal of Rheumatology, 2016
Background: The Disease Activity Score (DAS) in rheumatoid arthritis (RA) involving 28 joints and using erythrocyte stimulation rate (ESR) is used frequently. But the inability of DAS 28 ESR to reflect short-term changes in disease activity has given rise to DAS 28 using Creactive protein (CRP). The objective of the present study was to compare DAS 28 CRP with DAS 28 ESR. Methods: 294 patients of RA diagnosed as per ACR EULAR 2010 revised classification criteria for RA were included. New cutoff values of remission, low, moderate and high disease activity using DAS 28 CRP were defined. Result: There was a good correlation between DAS 28 ESR and DAS 28 CRP. On classifying the disease activity of the subjects according to new cutoff values of DAS 28 CRP, there was substantial agreement with classification according to DAS 28 ESR. Conclusion: DAS 28 CRP may be considered as an alternative to DAS 28 ESR.
RMD open, 2017
In most patients with rheumatoid arthritis (RA), Disease Activity Score 28-joint count C reactive protein (DAS28-CRP) is lower than DAS28 erythrocyte sedimentation rate (DAS28-ESR), suggesting that use of the DAS28-ESR cut-off to assess high disease activity (HDA) with DAS28-CRP may underestimate the number of patients with HDA. We determined the DAS28-CRP value corresponding to the validated DAS28-ESR cut-off for HDA. Baseline data were pooled from 2 clinical studies evaluating etanercept (ETN) plus methotrexate (MTX) or MTX in early RA; DAS28-CRP and DAS28-ESR were obtained, allowing the determination of the DAS28-CRP HDA value best corresponding to the DAS28-ESR cut-off of >5.1. At baseline, as expected, fewer patients had HDA by DAS28-CRP than DAS28-ESR; DAS28-CRP>5.1 and DAS28-ESR>5.1 had only modest agreement (κ coefficients 0.45-0.54). Mean DAS28-CRP and DAS28-ESR were 5.7 and 6.2, respectively, in the ETN+MTX group (n=571), and 6.0 and 6.5 in the MTX group (n=262). ...
Arthritis, 2015
Objective. To validate the agreement between the 28-joint disease activity score based on erythrocyte sedimentation rate (DAS28-ESR) and the 28-joint disease activity score based on C-reactive protein (DAS28-CRP) in a group of Danish patients with rheumatoid arthritis (RA). Methods. Data from 109 Danish RA patients initiating biologic treatment were analysed at baseline and following one year of treatment. Participants were retrospectively enrolled from a previous cohort study and were considered eligible for this project if CRP and ESR were measured at baseline and at the follow-up visit. To assess the extent of agreement between the two DAS28 definitions, the "European League Against Rheumatism" (EULAR) response criteria based on each definition were calculated with cross-classification. Weighted Kappa (κ) coefficients were calculated, and Bland-Altman plots were used to illustrate degree of agreement between DAS28 definitions. Results. The 75 eligible patients were clas...
Folia Medica, 2020
Introduction: The European League Against Rheumatism updates the recommendations for managing rheumatoid arthritis. Again, it is not specified which DAS28 is there in view (with erythrocyte sedimentation rate or C-reactive protein). Aim: The aim of the study is to check whether Disease Activity Score-28 (erythrocyte sedimentation rate) and Disease Activity Score-28 (C-reactive protein) represent equally the activity of rheumatoid arthritis in the course of treatment with biological agents. Materials and methods: In a retrospective study we analyzed the database of real clinical practice over a 12-month period of biological treatment of rheumatoid arthritis. Disease Activity Score-28 (erythrocyte sedimentation rate) and (C-reactive protein) are compared at the start and at the end of the study. Results: The mean difference between the two variants of disease activity scores at baseline and at the end of the study is significant (p < 0.001). The Disease Activity Score-28 (ery...
The value of changes in CRP and ESR for predicting treatment response in rheumatoid arthritis
APLAR Journal of Rheumatology, 2007
Aim: During treatment of rheumatoid arthritis (RA) the serum C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) decrease concurrent with clinical improvement. The aim of this paper is to investigate whether changes of these parameters could predict treatment response. Methods: Patients with active RA, requiring disease-modyfying antirheumatic drugs were entered into the study. Serum CRP and ESR were assessed at baseline and 24 weeks after the treatment. Response to treatment was assessed by the RA Disease activity Score 28 (DAS28) and DAS28-CRP response criteria. In statistical analysis the agreement between changes of CRP and ESR at the first stage of the treatment and DAS28/DAS28-CRP were determined as 'good', 'moderate' and 'none' responses. The relationship between changes in CRP and DAS28-CRP, ESR and DAS28 were also determined and compared. Results: Sixty-six patients with active RA entered the study. The mean age was 50 ± 18 years and the mean disease duration was 4.9 ± 5.8 years. After an average period of 24 weeks, 51 patients met the DAS28 and 49 patients met the DAS28-CRP response criteria as good or moderate responders. Over the treatment period a reduction of serum CRP predicted 90% of DAS28-CRP responders and reduction of ESR predicted 97% of DAS28 responders, whereas a lack of CRP or ESR reductions predicted 54% and 45% non-responders, respectively. Overall, the accuracy of changes in CRP and ESR in predicting treatment response according to DAS28-CRP and DAS28 response criteria were 77% and 73%, respectively. CRP/DAS28-CRP was more sensitive but less specific than ESR/DAS28 in predicting treatment response. Conclusion: Changes of CRP or ESR at the first stage of treatment can predict treatment response. Hence, measurement of serum CRP and ESR furnishes a reliable quantitative means for early anticipation of treatment response.
Rheumatology (Oxford, England), 2015
Objectives. The 28-joint DAS (DAS28), clinical disease activity index (CDAI) and simplified disease activity index (SDAI) are indices frequently used to assess disease activity in RA patients. Cutoff values were defined to classify the states of RA disease activity: remission, low, moderate and high. The aim of this work was to assess disease activity states classified by DAS28, CDAI and SDAI and to analyse their agreement in the Rheumatic Diseases Portuguese Register Reuma.pt. Methods. A total of 2795 patients and 14 440 visits were selected from Reuma.pt for analysis. Pearson's correlation coefficients (PCCs) were calculated for the three indices. McNemar's chi-squared tests, PCCs and kappa statistics were performed to analyse and compare the distribution of visits among all disease activity states and indices. Results. A strong correlation was found between the three indices throughout the 14 440 visits: r = 0.874 for DAS28/CDAI, r = 0.877 for DAS28/SDAI and r = 0.984 for CDAI/SDAI (all PCCs with P < 0.0001). However, when categorization in the different disease activity states was analysed, McNemar's chisquared tests and PCCs revealed significant disagreement between the cutoffs of the three indices. Conclusion. DAS28, CDAI and SDAI cutoffs do not translate into the same clinical information in Reuma.pt. Although this might be expected for the original DAS28 cutoffs , when compared with CDAI and SDAI significant disagreement was also found for the DAS28 modified cutoffs. For visits where patients are in CDAI or SDAI remission, we also find disagreement between these two indices, which may contradict previous conclusions that acute phase reactants add little to composite disease activity indices for RA.
International Journal of Rheumatic Diseases, 2017
Background/Purpose: To compare the performance of Disease Assessment Score of 28 joints-C-reactive protein (DAS-28-CRP), Clinical Disease Activity Index (CDAI) and Simplified Disease Activity Index (SDAI) composite measures to assess status of patients with rheumatoid arthritis (RA) on methotrexate, versus DAS-28 CRP as the gold standard. Methods: One hundred and thirty-five patients with RA as per the 2010 American College of Rheumatology/ European League Against Rheumatism criteria were included in the prospective study. The disease activity was assessed at baseline and at every 6 weeks for 24 weeks, by DAS-28-CRP, CDAI and SDAI. Patients were divided into groups of remission, low, moderate and high activity on the basis of predefined cutoffs for DAS-28-CRP, CDAI and SDAI. A Spearman correlation between composite measures and inter-group comparison of the measures was performed. Results: There was an excellent positive correlation between DAS-28-CRP and CDAI (linear weighted j baseline-0.545), DAS-28 CRP and SDAI (linear weighted j-0.689) at baseline. There was moderate agreement between DAS-28-CRP and CDAI (linear weighted j final visit-0.458) at final visit. There was moderate correlation between SDAI and DAS-28-CRP at final visit (linear weighted j-0.470). However, correlation between CDAI versus SDAI remained excellent at baseline and final visit. Patients in remission as per DAS-28-CRP had significantly more residual disease activity compared to SDAI and CDAI remission criteria. Conclusion: The study shows an excellent strong positive correlation between DAS-28-CRP, CDAI and SDAI at initial evaluation but not at final visit. SDAI-and CDAI-based remission criteria seem to be better than DAS-28-CRP-based remission criteria.