Validity of simplified disease activity index using CRP titer in comparison to disease activity score-28 joints in Iraqi patients with active Rheumatoid arthritis (original) (raw)
Related papers
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.
Lupus: Open Access, 2016
Objectives: Our objective was to evaluate the level of similarity between SDAI, CDAI, DAS28-ESR and DAS28-CRP in our study population which will help in the quick assessment of the disease for immediate treatment modalities. Methods: The study population consisted of 38 Rheumatoid Arthritis (RA) patients attending the OPD of our hospital. After a detailed medical history and anthropometric evaluation, all the participants were subjected to biochemical analysis like CRP, ESR and their disease activity scores were calculated using DAS calculator. SDAI and CDAI were also calculated. The correlations between the four indices were studied through the Pearson's correlation coefficient (r) and the similarity between these indices was evaluated through Kendall's (K) "tau" similarity coefficient. Results: The 38 RA patients were of mean age of 42.08 ± 12.92 years with the disease duration of mean of 36 months (1 month-20 years). The DAS28-ESR mean score was 5.56 ± 0.90. The DAS28-CRP mean score was 4.93 ± 0.86. The CDAI mean score was 26.45 ± 8.42 and that of SDAI was 28.20 ± 9.08. A positive, statistically significant correlation was noted between the four indices for RA activity. The level of similarity between these indices was good (K variation between 0.699 and 0.910). 42.1% of the patients were classified as 'high' disease activity level, when DAS28-ESR and DAS28-CRP scores were considered together. This proportion was of 42.1%, when comparing DAS28-CRP respectively to CDAI and SDAI, compared to 60.5% when DAS28-ESR and SDAI were considered whereas DAS28-ESR and CDAI classified 65.8% of the patients as 'high' disease activity. Finally, CDAI and SDAI classified the patients upto 60.5% as having a 'high' disease activity level. Conclusion: DAS28-CRP, DAS28-ESR, CDAI and SDAI correlated well for assessing the disease activity status for the RA patients. CDAI and especially SDAI have a good level of similarity with DAS28.
BMC Musculoskeletal Disorders, 2015
Background: Clinical disease activity index (CDAI) and simplified disease activity index (SDAI) are useful tools for the evaluation of disease activity in patients with rheumatoid arthritis (RA), but have not been comparatively validated in Moroccan population. Therefore, this study was designed to assess validity and reliability of CDAI and SDAI in comparison to disease activity score-28 joints (DAS-28) in Moroccan patients with RA. Methods: Patients with RA were included in a cross-sectional study. Patient characteristics and RA were collected. The disease activity was assessed by DAS-28, CDAI and SDAI. Patients were splitted into groups of remission, low, moderate and high activity on the basis of predefined cutoffs for DAS-28, CDAI, and SDAI. A Spearman correlation between composite indexes and inter-group comparison of the indexes were performed. Using DAS-28 as a gold standard, the Receiver operator characteristic (ROC) curve was used to assess the performance of a screening test at different levels. Results: The study was conducted with 103 patients of female predominance (87.4 %). Mean age was 49.7 ± 11.4 years. Median disease duration was in the order of 8 years [3-14]. There was an excellent correlation between DAS-28 and CDAI (r = 0.95, p <0.001), CDAI and SDAI (r = 0.90, p <0.001), and DAS-28 and SDAI (r = 0.92, p <0.001). There was a good inter-rater alignment between the DAS-28 and CDAI (Weighted kappa =0.743) and there was a moderate interrater alignment between the DAS-28 and SDAI (Weighted kappa =0.60), and also between the SDAI and CDAI (Weighted kappa = 0.589). There was no statistically significant difference between AUROC of CDAI and SDAI as both were performed equally well. Discussion: This study is the first Moroccan case study to compare the performance of both CDAI and SDAI in evaluation of disease activity in patients with RA. Our study showed that there was a direct and excellent correlation between DAS-28 and CDAI, and SDAI and DAS-28. Conclusion: Our study shows a strong positive correlation between DAS-28, CDAI and SDAI. The cutoff values for CDAI and SDAI used in western literature can be used with minor modifications in Moroccan scenario.
Clinical Rheumatology, 2012
Serial objective assessment of disease activity in rheumatoid arthritis (RA) is imperative to achieve remission. Routine Assessment of Patient Index Data 3 (RAPID3), an index without formal joint counts, appears attractive for evaluation of disease activity in RA patients in a busy clinical setting. This study aims to evaluate correlation and agreement of RAPID3 with Disease Activity Score 28 (DAS28) and Clinical Disease Activity Index (CDAI) in RA patients. All patients completed a Multidimensional Health Assessment Questionnaire (MDHAQ) at each visit. A physician/assessor 28-joint count and erythrocyte sedimentation rate were completed in 200 literate patients with RA to score DAS28, CDAI, and RAPID3. RAPID3 includes the three MDHAQ patient self-report RA core dataset measures for physical function, pain, and patient global estimate. Proposed RAPID3 (range, 0-30) severity categories of high (>12), moderate (6.1-12.0), low (3.1-6.0), and near remission
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.
A simplified disease activity index for rheumatoid arthritis for use in clinical practice
Rheumatology, 2003
Objective. The objective of this study was to verify the usefulness of a simple disease activity index (SDAI) for rheumatoid arthritis (RA). Methods. The SDAI is the numerical sum of five outcome parameters: tender and swollen joint count (based on a 28-joint assessment), patient and physician global assessment of disease activity wvisual analogue scale (VAS) 0-10 cmx and level of C-reactive protein (mgudl, normal <1 mgudl). Analysis initially focused on MN301, one of the three phase III clinical trials of leflunomide, in order to assess possible correlations between the SDAI and the Health Assessment Questionnaire (HAQ) and Disease Activity Score 28 (DAS 28). Results were then compared with the other two trials, MN302 and US301. A total of 1839 patients were evaluated. At baseline, 6 and 12 months, the SDAI, DAS 28, American College of Rheumatology (ACR) response criteria and mean HAQ scores were determined for each patient and compared by linear regression for significant correlation. The SDAI was compared qualitatively to the ACR 20% at 3, 6 and 12 months. The index was further validated by comparing the SDAI with survey results obtained from rheumatologists' evaluations of disease activity in test cases. The survey results included defining categorical changes in the SDAI indicating major, minor or no improvement in disease activity in response to treatment. Changes in total Sharp score at 6 and 12 months of treatment were determined for each of these categories of the SDAI and for comparable categories of the DAS 28. Results. The mean SDAI calculated for patients at baseline in study MN301 was 50.06 (range 25.10-96.10) and was, respectively, 50.55 (range 22.10-98.10) and 43.20 (range 12.90-78.20) in studies MN302 and US301. In all three trials, the SDAI was correlated with a high level of statistical significance to the DAS 28 and HAQ scores at baseline, endpoint and change at endpoint. Patients achieving the ACR 20, 50, 70 or 90% response showed proportionate changes in the SDAI. Analysis of surveyed physician responses showed a significant association between the perception of disease activity and the SDAI, as well as changes in the SDAI. Qualitative analysis of radiographic progression at 6 and 12 months for patients showing either major, minor or no improvement of the SDAI showed correspondingly larger increases of the total Sharp score at 12 months. Conclusion. The SDAI is a valid and sensitive assessment of disease activity and treatment response that is comparable with the DAS 28 and ACR response criteria; it is easy to calculate and therefore a viable tool for day-to-day clinical assessment of RA treatment. Overall results indicate that the SDAI has content, criterion and construct validity. http://rheumatology.oxfordjournals.org/ Downloaded from 246 J. S. Smolen et al. 246 J. S. Smolen et al. by guest on June 1, 2013 http://rheumatology.oxfordjournals.org/ Downloaded from 250 J. S. Smolen et al. 250 J. S. Smolen et al. by guest on June 1, 2013 http://rheumatology.oxfordjournals.org/ Downloaded from 254 J. S. Smolen et al. 254 J. S. Smolen et al. by guest on June 1, 2013 http://rheumatology.oxfordjournals.org/ Downloaded from 256 J. S. Smolen et al. 256 J. S. Smolen et al. by guest on
Comparative study of indices of activity evaluation in rheumatoid arthritis
Annals of Physical and Rehabilitation Medicine, 2011
Introduction. -Choosing between the different indices of activity evaluation in RA is often difficult considering the very heterogeneous clinical expression of the disease. The objective of our study was to evaluate the level of similarity between SDAI, CDAI, DAS28-ESR and DAS28-CRP indices in the evaluation of RA activity. Patients and methods. -In this transversal study, a total of 100 patients with RA responding to the ACR 87 criteria were followed up for a period of 20 months. The correlations between the four indices were studied through the Pearson's correlation coefficient (r). The similarity between these tools was evaluated through Kendall's (K) ''tau'' similarity coefficient.