Agreement Between the DAS28-CRP Assessed with 3 and 4 Variables in Patients with Rheumatoid Arthritis Treated with Biological Agents in the Daily Clinic

Journal of Rheumatology - Tập 40 Số 4 - Trang 379-385 - 2013
Ole Rintek Madsen1
1From the Department of Rheumatology/Internal Medicine C, Copenhagen University Hospital Gentofte, and the DANBIO Registry, Copenhagen University Hospital, Glostrup, Denmark.

Tóm tắt

Objective.The Disease Activity Score-28-C-reactive Protein 4 [DAS28-CRP(4)] composite measure for rheumatoid arthritis (RA) is based on 4 variables: tender and swollen joint counts, CRP, and patient global assessment. DAS28-CRP(3) includes only 3 variables, because patient global assessment has been omitted. Thresholds for low and high disease activity are the same for the 2 scores. The objective of our study was to compare the 2 DAS scores and their responses on the individual patient level.Methods.Baseline and 12-week disease activity data from 239 patients with RA treated with a biological agent were extracted from the Danish registry for biological treatment (DANBIO). Cohen's effect sizes (ES) and disease activity levels according to the DAS thresholds were assessed. The Bland-Altman method was used to examine the bias between the DAS scores and the 95% limits of agreement (LoA).Results.Baseline values for DAS28-CRP(4) and DAS28-CRP(3) were 4.8 ± 1.2 and 4.6 ± 1.1, respectively. At 12 weeks, DAS28-CRP(4) had improved by −1.39 ± 1.34 (p < 0.0001). At that timepoint the bias of DAS28-CRP(3) was −0.07 (LoA −0.69, 0.55) (p < 0.0001). The bias of the DAS28-CRP(3) response was +0.21 (LoA −0.49, 0.91) (p < 0.0001). ES for DAS28-CRP(4) was 1.2 ± 1.1 versus 1.1 ± 1.1 for DAS28-CRP(3) (p < 0.0001). Compared to DAS28-CRP(4), DAS28-CRP(3) categorized 33% fewer patients as having a high level of disease activity, 8% fewer patients as good responders, and 12% more patients as nonresponders.Conclusion.Mean values of DAS28-CRP(4) and DAS28-CRP(3) agreed well, but in the individual patient the difference between the scores and their responses may be substantial.

Từ khóa


Tài liệu tham khảo

10.1136/ard.49.11.916

10.1136/ard.51.2.177

10.1002/art.1780380107

10.1002/1529-0131(199810)41:10<1845::AID-ART17>3.0.CO;2-K

10.1136/ard.62.2.151

10.2174/157339708786263951

10.1016/j.rdc.2009.10.001

Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. [Internet. Accessed December 21, 2012.] Available from: http://www.das-score.nl

10.1136/ard.2011.149765

10.1002/art.1780390105

van Gestel, 1999, ACR and EULAR improvement criteria have comparable validity in rheumatoid arthritis trials. American College of Rheumatology/European League of Associations for Rheumatology, J Rheumatol, 26, 705

10.1136/ard.2008.097683

10.1136/ard.2009.118307

10.1136/ard.2008.097345

10.1002/1529-0131(199805)41:5<942::AID-ART26>3.0.CO;2-B

10.1007/s10067-011-1847-6

10.1002/art.27227

Aletaha, 2005, The Simplified Disease Activity Index (SDAI) and the Clinical Disease Activity Index (CDAI): A review of their usefulness and validity in rheumatoid arthritis, Clin Exp Rheumatol, 23, S100

10.1016/S0140-6736(86)90837-8

Bland, 1996, Statistics notes: measurement error, BMJ, 313, 744, 10.1136/bmj.313.7059.744

Cohen J . Statistical power analysis for the behavioral sciences. New York: Academic Press; 1977.

10.1136/ard.2006.051706

10.1136/ard.2007.084459

Kushner, 1991, C-reactive protein in rheumatology, Arthritis Rheum, 34, 1065, 10.1002/art.1780340819

Talstad, 1983, Influence of plasma proteins on erythrocyte morphology and sedimentation, Scand J Haematol, 31, 478, 10.1111/j.1600-0609.1983.tb01547.x

10.1093/rheumatology/32.suppl_3.9

Mallya, 1982, Correlation of clinical parameters of disease activity in rheumatoid arthritis with serum concentration of C-reactive protein and erythrocyte sedimentation rate, J Rheumatol, 9, 224

Wolfe, 1997, Comparative usefulness of C-reactive protein and erythrocyte sedimentation rate in patients with rheumatoid arthritis, J Rheumatol, 24, 1477

10.1093/rheumatology/keq117

10.1136/ard.2006.063834

10.1136/ard.2006.054205

Castrejõn, 2008, Are the C-reactive protein values and erythrocyte sedimentation rate equivalent when estimating the 28-joint Disease Activity Score in rheumatoid arthritis?, Clin Exp Rheumatol, 26, 769

Nicolau, 2004, Sources of discrepancy in patient and physician global assessments of rheumatoid arthritis disease activity, J Rheumatol, 31, 1293

10.1093/rheumatology/ker425

Thông tin
Thông tin xuất bản

Journal of Rheumatology

Tập 40 Số 4

379-385

Thông tin tác giả