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Johnson TM, Michaud K, England BR. Measures of Rheumatoid Arthritis Disease Activity. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:4-26. [PMID: 33091244 DOI: 10.1002/acr.24336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/22/2020] [Indexed: 02/02/2023]
Affiliation(s)
- Tate M Johnson
- US Department of Veterans Affairs Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, and FORWARD, The National Databank for Rheumatic Diseases, Wichita, Kansas
| | - Bryant R England
- US Department of Veterans Affairs Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
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Validity of 7-Joint Versus Simplified 12-Joint Ultrasonography Scoring Systems in Assessment of Rheumatoid Arthritis Activity. J Clin Rheumatol 2020; 25:264-271. [PMID: 29965853 DOI: 10.1097/rhu.0000000000000847] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Musculoskeletal ultrasonography (US) is an objective tool for the evaluation of disease activity in rheumatoid arthritis (RA) patients. There is no consensus on the exact number of joints that should be examined. Examination of reduced joint count is more practical than the comprehensive one. OBJECTIVES This is a cross-sectional study investigated the validity of a 7-joint US score (US7) in assessment of joint inflammation in RA patients compared with a simplified 12-joint US score (US12) and correlated both to composite disease activity indices. METHODS The activity status of 50 RA patients was assessed clinically and ultrasonographically. The disease activity was calculated using 3 composite indices. Ultrasonography was performed by 1 blinded rheumatologist, using power Doppler (PD) and gray-scale (GS) US examination. The US7 and simplified US12 were performed as originally described. However, the GS synovitis and PD synovitis of US12 were computed in 2 separate scores instead of 1. Two sum US7 scores were added, sum (GS) US7 and sum (PD) US7 after summating synovitis and tenosynovitis scores. Ultrasonography interobserver/intraobserver reliability was evaluated on 40 stored images. RESULTS Correlation coefficient between the different ultrasonographic scores showed no difference. The GS scores showed no correlation with disease activity parameters; however, the PD scores did. The sum (PD) US7 was the only score that showed significant correlation with the 3 different composite disease indices. CONCLUSIONS All studied US scores proved valid in assessment of disease activity status in RA. This is in favor of using the less-time-consuming US7 scores. The strongest correlation found with sum (PD) US7 confirmed the importance of incorporating the tendon in the disease activity assessment.
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Evaluating the role of serum sclerostin as an indicator of activity and damage in Egyptian patients with rheumatoid arthritis: university hospital experience. Clin Rheumatol 2019; 39:1121-1130. [DOI: 10.1007/s10067-019-04878-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 11/25/2019] [Accepted: 12/04/2019] [Indexed: 12/15/2022]
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Nessrine A, Siham D, Meryem B, Samira EF, Taoufik H. Should the Ultrasound of Hands be a Component of Rheumatoid Arthritis Remission Criteria? Curr Rheumatol Rev 2019; 15:312-315. [PMID: 30599109 DOI: 10.2174/1573397115666181231115233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 11/20/2018] [Accepted: 12/23/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The definition of remission in Rheumatoid Arthritis (RA) is still difficult to determine. An ultrasound of the hands may be important in helping confirm clinical remission. OBJECTIVE This study's aim was to evaluate the interest in using an ultrasound of the hands to confirm clinical remission, as well as comparing the various remission scores (DAS 28 VS, DAS 28 CRP, and SDAI) and the ultrasound data, in order to deduce the most accurate score to confirm this remission. METHODS In this prospective monocentric study, we studied patients with rheumatoid arthritis in clinical remission, according to DAS 28 VS, for at least 3 months without corticosteroid therapy. An ultrasound mode B / Doppler of the hands was taken by an experienced rheumatologist, involving 22 joints: wrists, Metacarpophalangeal (MCP) joints and proximal interphalangeal joints (PPI) bilaterally. RESULTS Fifty-one patients were included. They were classified in remission according to DAS 28 VS as well as DAS 28 CRP, whereas the remission according to SDAI was achieved in 66.7% of our patients. Synovial hypertrophy and power Doppler were present in respectively 65% and 25% of the patients. SDAI was the most accurate score to confirm RA remission (p < 0.003). CONCLUSION SDAI appears to be the most appropriate score for the definition of remission in rheumatoid arthritis, but despite the use of the latter, ultrasound synovitis may still be present. Further work deserves to be done to clarify the value of ultrasound evaluation in the definition of RA remission.
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Affiliation(s)
- Akasbi Nessrine
- Rheumatology Department, University Hospital Center, Hassan II Fez, Faculty of Medicine, University Sidi Mohammed Ben Abdellah, Fez, Morocco
| | - Driouach Siham
- Rheumatology Department, University Hospital Center, Hassan II Fez, Faculty of Medicine, University Sidi Mohammed Ben Abdellah, Fez, Morocco
| | - Baya Meryem
- Department of Epidemiology and Public Health, University Hospital Center, Hassan II Fez, Faculty of Medicine, University Sidi Mohammed Ben Abdellah, Fez, Morocco
| | - El Fakir Samira
- Department of Epidemiology and Public Health, University Hospital Center, Hassan II Fez, Faculty of Medicine, University Sidi Mohammed Ben Abdellah, Fez, Morocco
| | - Harzy Taoufik
- Rheumatology Department, University Hospital Center, Hassan II Fez, Faculty of Medicine, University Sidi Mohammed Ben Abdellah, Fez, Morocco
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Salama SM. Comparison between the roles of musculoskeletal ultrasound and magnetic resonance imaging in detection of joint inflammation and destruction in rheumatoid arthritis. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2018. [DOI: 10.4103/1110-161x.247617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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de Miguel E, Pecondón-Español A, Castaño-Sánchez M, Corrales A, Gutierrez-Polo R, Rodriguez-Gomez M, Pinto-Tasende JA, Rivas JL, Ivorra-Cortés J. A reduced 12-joint ultrasound examination predicts lack of X-ray progression better than clinical remission criteria in patients with rheumatoid arthritis. Rheumatol Int 2017; 37:1347-1356. [PMID: 28389854 DOI: 10.1007/s00296-017-3714-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 03/30/2017] [Indexed: 11/30/2022]
Abstract
To study the predictive value of clinical remission definitions and ultrasound (US) examination on X-ray progression in rheumatoid arthritis (RA). This was an observational prospective multicenter 1-year follow-up cohort of RA patients with moderate disease activity (3.2 < DAS28 ≤ 5.1) who started anti-TNF therapy. DAS28ESR, DAS28CRP, SDAI, CDAI, and ACR/EULAR remission criteria were applied and reduced 12-joint US examination was performed at baseline and at 6 and 12 months. At baseline and month 12, radiographs of hands and feet were obtained in a subset of patients. A blind independent reader scored radiographs. X-ray progression was defined as Sharp van der Heijde change score >1 and no progression was defined as ≤0. 319 of 357 patients completed the study; patients had a mean (SD) age of 53.5 (13.1) years, with a disease duration of 7.5 (7.1) years. Laboratory, clinical, and US values significantly improved at month 6, except CRP, with additional improvement at month 12. Remission and low disease activity rates increased at follow-up. In the subset of 115 patients with radiological studies, clinical remission by any definition was not significantly associated with X-ray progression. Patients without PD signal at baseline and month 6 were a lower risk of X-ray progression than patients with PD signal, OR 0.197 (95% CI 0.046-0.861) and 0.134 (95% CI 0.047-0.378), respectively. Absence of PD signal, but not clinical remission predicts lack of X-ray progression. A feasible 12-joint US examination may add relevant information to RA remission criteria.
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Affiliation(s)
- Eugenio de Miguel
- Rheumatology Department, Hospital Universitario La Paz, Pº de la Castellana 261, 28046, Madrid, Spain.
| | | | - Manuel Castaño-Sánchez
- Rheumatology Department, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Alfonso Corrales
- Rheumatology Department, Hospital Marqués de Valdecilla, Santander, Spain
| | | | | | - Jose A Pinto-Tasende
- Rheumatology Department, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
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Taneja A, Oosterholt SP, Danhof M, Della Pasqua O. Biomarker exposure-response relationships as the basis for rational dose selection: Lessons from a simulation exercise using a selective COX-2 inhibitor. J Clin Pharmacol 2015; 56:609-21. [DOI: 10.1002/jcph.629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 08/26/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Amit Taneja
- Division of Pharmacology; Leiden Academic Centre for Drug Research; Leiden University; Leiden The Netherlands
| | - Sean P. Oosterholt
- Division of Pharmacology; Leiden Academic Centre for Drug Research; Leiden University; Leiden The Netherlands
| | - Meindert Danhof
- Division of Pharmacology; Leiden Academic Centre for Drug Research; Leiden University; Leiden The Netherlands
| | - Oscar Della Pasqua
- Division of Pharmacology; Leiden Academic Centre for Drug Research; Leiden University; Leiden The Netherlands
- Clinical Pharmacology & Therapeutics; University College London; London UK
- Clinical Pharmacology Modelling & Simulation; GlaxoSmithKline; Stockley Park UK
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Aletaha D, Alasti F, Smolen JS. Optimisation of a treat-to-target approach in rheumatoid arthritis: strategies for the 3-month time point. Ann Rheum Dis 2015; 75:1479-85. [DOI: 10.1136/annrheumdis-2015-208324] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 09/06/2015] [Indexed: 01/29/2023]
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Navarro-Millán IY, Chen L, Greenberg JD, Pappas DA, Curtis JR. Predictors and persistence of new-onset clinical remission in rheumatoid arthritis patients. Semin Arthritis Rheum 2013; 43:137-43. [PMID: 23742957 PMCID: PMC4184191 DOI: 10.1016/j.semarthrit.2013.02.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 02/07/2013] [Accepted: 02/15/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine the prevalence and persistence of new-onset clinical remission in rheumatoid arthritis (RA) patients. METHODS The Consortium of Rheumatology Researchers of North America (CORRONA) cohort was used to examine the prevalence of remission and associated comorbidities and RA therapies according to the 2011 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) remission criteria. Factors influencing the likelihood of remaining in remission were identified by logistic regression with generalized estimating equations. Analysis of variance and Tukey's test were used to determine differences in disability according to whether RA patients had been in remission or only low disease activity (LDA). RESULTS A total of 2105 individuals met ACR/EULAR remission criteria at the most recent visit within CORRONA, yielding an 8% point prevalence of remission. Patients with certain comorbidities (e.g., heart failure) were significantly less likely to achieve or remain in remission compared to those without these conditions (p < 0.001 for each). Among prednisone users, the prevalence of remission was 1-6% (depending on dose) higher compared to those not on prednisone (10%). More than 50% of patients who had consistently been in remission for ≥1 year were able to remain in remission over the next year. Patients consistently in remission had less disability than patients who achieved LDA or who fluctuated between remission and LDA. CONCLUSION Patients consistently in remission for at least 1 year had a high likelihood to remain in remission. These individuals might be considered the most likely candidates for de-escalation or withdrawal of RA treatments.
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Affiliation(s)
| | - Lang Chen
- University of Alabama at Birmingham; Birmingham, AL
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Calprotectin in rheumatoid arthritis : association with disease activity in a cross-sectional and a longitudinal cohort. Mol Diagn Ther 2013; 17:49-56. [PMID: 23329363 DOI: 10.1007/s40291-013-0016-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Calprotectin is potentially a more sensitive biomarker of disease activity in rheumatoid arthritis (RA) than conventional acute-phase proteins such as the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) because it directly reflects inflammation in the synovium and synovial fluid rather than systemic inflammatory activity. OBJECTIVE The aim of this study was to evaluate relationships between serum calprotectin levels, disease activity, and response to treatment. Calprotectin was also investigated as a predictive marker of clinical response. METHODS This observational study included selected cohorts of patients with RA treated at La Paz University Hospital, Madrid, Spain. Associations between serum calprotectin levels and clinical and laboratory parameters were analyzed in a cross-sectional cohort of 60 patients with varying disease activity, and changes in calprotectin levels in response to treatment with infliximab were analyzed at baseline and after 3 and 6 months of treatment in a longitudinal cohort of 20 patients with very active disease. RESULTS In the cross-sectional cohort, calprotectin levels correlated with rheumatoid factor levels (r = 0.25; p < 0.05) but not with titers of antibodies to cyclic citrullinated peptide. Significant correlations were also observed between calprotectin levels and the 28 swollen joint count (28-SJC), Disease Activity Score based on a 28-joint count (DAS28), Simplified Disease Activity Index (SDAI), ESR, and CRP levels. In the longitudinal cohort, calprotectin levels at baseline were not predictive of response to treatment but significantly decreased during treatment in responders (p < 0.0001). CONCLUSION Calprotectin levels strongly correlate with clinical and laboratory assessments of joint inflammation and also decrease in response to treatment, indicating that calprotectin is a promising marker for assessment and monitoring of disease activity in patients with RA. Investigations are required to further evaluate its diagnostic, prognostic, and therapeutic potential.
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Keystone EC, Smolen J, van Riel P. Developing an effective treatment algorithm for rheumatoid arthritis. Rheumatology (Oxford) 2012; 51 Suppl 5:v48-54. [PMID: 22718927 DOI: 10.1093/rheumatology/kes122] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
RA is defined by the interrelated triad of disease activity, joint damage and disability. Although disease activity and its associated disability are reversible, joint damage and its associated disability are not. Thus, an important goal of RA therapy is to maximally reduce disease activity and thereby mitigate the accumulation of irreversible joint damage. Treatment for patients with RA should be initiated early and aggressively, with frequent assessments and a goal of achieving remission as quickly as possible after treatment initiation. We propose a treatment algorithm that recommends early and aggressive therapy with high-dose MTX therapy (15-25 mg/week), which may include moderate doses of glucocorticoids. The goal is to achieve low disease activity (determined by a composite measure that includes joint counts) within 3-6 months. If low disease activity is not achieved by 6 months, another conventional DMARD or a biologic agent should be added to the treatment regimen or patients should be switched to another DMARD plus a glucocorticoid. Once low disease activity is achieved, the treatment goal for the ensuing 3-6 months becomes disease remission.
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Affiliation(s)
- Edward C Keystone
- University of Toronto, Department of Immunology, Toronto, ON, Canada.
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Ghosh P, Kandhare AD, Kumar VS, Rajmane AR, Adil M, Bodhankar SL. Determination of clinical outcome and pharmacoeconomics of anti–rheumatoid arthritis therapy using CDAI, EQ–5D–3L and EQ–VAS as indices of disease amelioration. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2012. [DOI: 10.1016/s2222-1808(12)60242-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Evaluation of self-report questionnaires for assessing rheumatoid arthritis activity: A cross-sectional study of RAPID3 and RADAI5 and flare detection in 200 patients. Joint Bone Spine 2012; 79:57-62. [DOI: 10.1016/j.jbspin.2011.03.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2011] [Indexed: 01/23/2023]
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Baseline HAQ and SF-36 questionnaire scores cannot predict clinical remission, radiographic progression or the need for biological therapy in a three-year prospective study of a Brazilian early rheumatoid arthritis cohort. Rheumatol Int 2011; 32:3937-43. [PMID: 22198690 DOI: 10.1007/s00296-011-2261-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Accepted: 12/08/2011] [Indexed: 10/14/2022]
Abstract
This study evaluates prospectively whether baseline scores [Health Assessment Questionnaire (HAQ) and SF-36] can predict clinical and radiographic evolution in a cohort of early rheumatoid arthritis (RA) during a 3-year follow-up. Forty consecutive early RA patients were followed for 3 years, while receiving standardized treatment according to a pre-established protocol. HAQ and SF-36 were administered at the initial evaluation and at 3, 6, 12, 18, 24 and 36 months. Hands and feet radiographs were obtained at the initial evaluation and at 12, 24 and 36 months. Preselected outcomes were the occurrence of radiographic erosions, the achievement of an EULAR remission, low disease activity status and the need for biological therapy. The mean age at onset was 45 years with a 90% female predominance. Erosions were found in 42% of patients at T0 and in 70% after 3 years (P < 0.001). At T0, the proportion of patients in remission, low, moderate or high disease activity was 0, 0, 7.5 and 92.5% and 22.5, 7.5, 32.5 and 37.5%, respectively, at 3 years. The mean baseline HAQ score was 1.89 and 0.77 by the third year (P < 0.0001). Most SF-36 domains showed significant improvement except for general state and vitality. Biological therapy was deemed necessary in 22.5% of patients. The initial HAQ and SF-36 scores were not associated with clinical remission, bone erosions or the need for biological therapy at 36 months. The HAQ and SF-36 scores measured at baseline could not predict at 3 years, the preselected outcomes in a Brazilian cohort.
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da Mota LMH, Dos Santos Neto LL, de Carvalho JF, Pereira IA, Burlingame R, Ménard HA, Laurindo IMM. The presence of anti-citrullinated protein antibodies (ACPA) and rheumatoid factor on patients with rheumatoid arthritis (RA) does not interfere with the chance of clinical remission in a follow-up of 3 years. Rheumatol Int 2011; 32:3807-12. [PMID: 22187055 DOI: 10.1007/s00296-011-2260-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 12/08/2011] [Indexed: 12/29/2022]
Abstract
Autoantibodies in early rheumatoid arthritis (RA) have important diagnostic value. The association between the presence of autoantibodies against cyclic citrullinated peptide and the response to treatment is controversial. To prospectively evaluate a cohort of patients with early rheumatoid arthritis (<12 months of symptoms) in order to determine the association between serological markers (rheumatoid factor (RF), anti-citrullinated protein antibodies) such as anti-cyclic citrullinated peptide antibodies (anti-CCP) and citrullinated anti-vimentin (anti-Sa) with the occurrence of clinical remission, forty patients diagnosed with early RA at the time of diagnosis were evaluated and followed for 3 years, in use of standardized therapeutic treatment. Demographic and clinical data were recorded, disease activity score 28 (DAS 28), as well as serology tests (ELISA) for RF (IgM, IgG, and IgA), anti-CCP (CCP2, CCP3, and CCP3.1) and anti-Sa in the initial evaluation and at 3, 6, 12, 18, 24, and 36 months of follow-up. The outcome evaluated was the percentage of patients with clinical remission, which was defined by DAS 28 lower than 2.6. Comparisons were made through the Student t test, mixed-effects regression analysis, and analysis of variance (significance level of 5%). The mean age was 45 years, and a female predominance was observed (90%). At the time of diagnosis, RF was observed in 50% of cases (RF IgA-42%, RF IgG-30%, and RF IgM-50%), anti-CCP in 50% (no difference between CCP2, CCP3, and CCP3.1) and anti-Sa in 10%. After 3 years, no change in the RF prevalence and anti-CCP was observed, but the anti-Sa increased to 17.5% (P = 0.001). The percentage of patients in remission, low, moderate, and intense disease activity, according to the DAS 28, was of 0, 0, 7.5, and 92.5% (initial evaluation) and 22.5, 7.5, 32.5, and 37.5% (after 3 years). There were no associations of the presence of autoantibodies in baseline evaluation and in serial analysis with the percentage of clinical remission during follow-up of 3 years The presence of autoantibodies in early RA has no predictive value for clinical remission in early RA.
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Affiliation(s)
- Licia Maria Henrique da Mota
- Rheumatology Division, Hospital Universitário de Brasília da Universidade de Brasília, SHLS 716/916 Bloco E salas 501-502, Centro Médico de Brasília, Asa Sul, Brasilia, DF CEP: 71660020, Brazil.
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Hamdi W, Néji O, Ghannouchi M, Kaffel D, Kchir M. Comparative study of indices of activity evaluation in rheumatoid arthritis. Ann Phys Rehabil Med 2011; 54:421-8. [DOI: 10.1016/j.rehab.2011.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 09/06/2011] [Accepted: 09/08/2011] [Indexed: 11/26/2022]
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Ghosh A, Ghosh B, Pain S, Pande A, Saha S, Banerjee A, Biswas AB. Comparison between DAS28, CDAI and HAQ-DI as tools to monitor early rheumatoid arthritis patients in eastern India. INDIAN JOURNAL OF RHEUMATOLOGY 2011. [DOI: 10.1016/s0973-3698(11)60073-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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[Defining remission in Rheumatoid Arthritis. New ACR/EULAR criteria]. ACTA ACUST UNITED AC 2011; 6S3:S12-5. [PMID: 21794765 DOI: 10.1016/j.reuma.2010.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 10/27/2010] [Indexed: 11/22/2022]
Abstract
Remission is the ideal treatment objective in the management of rheumatoid arthritis. To define remission, stringent criteria are needed which allow clinicians to assess the presence of active disease and which should be reliable enough to support therapeutic decisions. Currently there are many different remission classifications and none has been validated against important outcome measures such as the absence of progression of joint damage and disability. Recently, a subcommittee of the ACR and EULAR has proposed new criteria for remission based on a categorical classification and a composite score like SDAI allowing their use in clinical practice.
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van Vollenhoven RF, Felson D, Strand V, Weinblatt ME, Luijtens K, Keystone EC. American College of Rheumatology hybrid analysis of certolizumab pegol plus methotrexate in patients with active rheumatoid arthritis: data from a 52-week phase III trial. Arthritis Care Res (Hoboken) 2011; 63:128-34. [PMID: 20799264 DOI: 10.1002/acr.20331] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The American College of Rheumatology (ACR) hybrid (a modified mean percent response to treatment) was officially recommended by the ACR as a revision to 20%, 50%, and 70% response criteria (ACR20/50/70) scores, but has not been tested in clinical trials. We performed a post hoc analysis of a phase III study of certolizumab pegol (Rheumatoid Arthritis Prevention of Structural Damage 1 [RAPID 1]) using the ACR hybrid. METHODS Patients with active rheumatoid arthritis were randomized to certolizumab pegol (200 mg or 400 mg every other week) plus methotrexate or placebo plus methotrexate. ACR hybrid scores were compared with ACR20/50/70 outcomes. RESULTS Differences between active treatment and placebo were significant throughout the study using the ACR20 and ACR hybrid outcomes. In the certolizumab pegol 200 mg group, the median ACR hybrid score at week 52 (last observation carried forward) was 49.99. A total of 258 (65.8%) of 392 and 172 (43.9%) of 392 patients had ACR20 and ACR50 responses, respectively. An additional 55 patients (14.0%) and 59 patients (15.1%) had mean improvements in ACR core measures of ≥ 20% and ≥ 50%, respectively, and therefore had positive ACR hybrid scores, despite lacking ACR20 and ACR50 responses, respectively. In the placebo group, median ACR hybrid scores were <10 at most time points; unlike other measures, the ACR hybrid measure indicated worsening scores for many patients. CONCLUSION ACR hybrid analysis had greater sensitivity than traditional ACR20/50/70 criteria, demonstrating improvements in ACR20 nonresponders treated with certolizumab pegol. Negligible benefit was observed with placebo using ACR hybrid analysis.
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Chung SJ, Kwon YJ, Park MC, Park YB, Lee SK. The correlation between increased serum concentrations of interleukin-6 family cytokines and disease activity in rheumatoid arthritis patients. Yonsei Med J 2011; 52:113-20. [PMID: 21155043 PMCID: PMC3017685 DOI: 10.3349/ymj.2011.52.1.113] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study was performed to determine whether the serum concentrations of interleukin (IL)-6 family cytokines are elevated in patients with rheumatoid arthritis (RA) and to investigate the relationship between IL-6 family cytokine levels and disease activity in RA patients. MATERIALS AND METHODS We obtained serum samples from 40 patients with RA and 40 age- and sex- matched healthy controls, and we assessed the clinical parameters of disease activity, including the 28-joint disease activity score (DAS28) and C-reactive protein (CRP) levels. Serum samples from five patients with high disease activity (DAS28 > 5.1) were also collected at the eighth week of treatment. Serum concentrations of IL-6, IL-11, and leukemia inhibitory factor (LIF) were measured using an enzyme-linked immunosorbent assay (ELISA). RESULTS Serum concentrations of IL-6 family cytokines, including IL-6, IL-11, and LIF, were significantly elevated in patients with RA compared to those of healthy controls. Although there was no significant relationship between IL-6 family cytokine levels and DAS28, the IL-6 levels of patients with RA showed a significant correlation with CRP levels. After eight weeks of medical treatment in patients with high disease activity, a decrease in DAS28 was associated with a significant decrease in the serum concentrations of IL-6 and IL-11. CONCLUSION The serum concentrations of IL-6 family cytokines were significantly elevated in patients with RA, and they decreased with medical treatment. These findings suggest a possible role for IL-6 family cytokines in the pathogenesis of RA.
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Affiliation(s)
- Soo-Jin Chung
- Division of Rheumatology, Department of Internal Medicine, Institute for Immunology and Immunologic Disease, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Jin Kwon
- Division of Rheumatology, Department of Internal Medicine, Institute for Immunology and Immunologic Disease, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Min-Chan Park
- Division of Rheumatology, Department of Internal Medicine, Institute for Immunology and Immunologic Disease, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Beom Park
- Division of Rheumatology, Department of Internal Medicine, Institute for Immunology and Immunologic Disease, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Soo-Kon Lee
- Division of Rheumatology, Department of Internal Medicine, Institute for Immunology and Immunologic Disease, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
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Bentley MJ, Greenberg JD, Reed GW. A modified rheumatoid arthritis disease activity score without acute-phase reactants (mDAS28) for epidemiological research. J Rheumatol 2010; 37:1607-14. [PMID: 20595282 DOI: 10.3899/jrheum.090831] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To develop and validate a modified version of the Disease Activity Score with 28 joint count (mDAS28), for use in epidemiological research, when acute-phase reactant values are unavailable. METHODS In a cross-sectional development cohort (5729 patients), statistically significant predictors of the logarithm of erythrocyte sedimentation rate (lnESR) were identified. After computation of the mDAS28, a cross-sectional validation cohort (5578 patients) was used to evaluate internal, criterion, and construct validities. The ability of the mDAS28 to discriminate between disease states was also assessed. A second validation cohort (longitudinal, 336 pairs of patient visits) was used to assess sensitivity to change. RESULTS Significant predictors of lnESR included tender and swollen joints with 28 counts, patient's and physician's assessments of global health, and patient's assessment of pain (visual analog scale 0-100 mm) and a physical function (modified Health Assessment Questionnaire 0-3; mHAQ). Satisfactory internal validity (alpha = 0.72) and strong criterion validity compared to the DAS28, the Simplified Disease Activity Index (SDAI), and the Clinical Disease Activity Index (CDAI) (r = 0.87-0.96) were found. Predictive validity was demonstrated by good correlation with the mHAQ (r = 0.58). The mDAS28 showed substantial agreement with the DAS28, SDAI, and CDAI in discriminating between disease states (kappa = 0.70-0.77) and moderate to substantial agreement between response levels (kappa = 0.52-0.73). Both mDAS28 and DAS28 measures classified patients similarly in remission compared to the SDAI and CDAI. The mDAS28 was superior in detecting change (standardized response mean = 0.58) followed by the DAS28, CDAI, and SDAI. CONCLUSION The mDAS28 is a valid and sensitive tool to assess disease activity in epidemiological research, as an alternative to the DAS28, when acute-phase reactant values are unavailable.
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Affiliation(s)
- Mary J Bentley
- Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA.
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Le Loët X, Kozyreff Meurice M, Lequerré T, Vittecoq O. Polyarthrite rhumatoïde : définitions de la réponse, des différents niveaux d’activité et de la rémission. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.monrhu.2009.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Balsa A, de Miguel E, Castillo C, Peiteado D, Martín-Mola E. Superiority of SDAI over DAS-28 in assessment of remission in rheumatoid arthritis patients using power Doppler ultrasonography as a gold standard. Rheumatology (Oxford) 2010; 49:683-90. [PMID: 20047979 DOI: 10.1093/rheumatology/kep442] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate the accuracy of composite scores in classifying RA patients who are in remission using the absence of inflammatory activity detected by ultrasound (US) as a gold standard. METHODS Ninety-seven RA patients who were classified by their rheumatologists as being in remission were studied. Disease activity was assessed by the DAS-28 and simplified disease activity index (SDAI). US examination was performed in mode B and power Doppler (PD) in 42 joints. RESULTS Synovial hypertrophy (SH) and PD were present in 92 (94.8%) and 41 (42.3%) patients. If we consider 'remission' to be the absence of joints with PD signal, no differences were found by DAS-28 between patients in remission and those not in remission, although differences were present by SDAI. We then calculated the sensitivity (S), specificity (Sp) and positive likelihood ratio (LR) of different SDAI cut-off points to predict absence of PD signal. SDAI < 5 had an S of 65% (95% CI 52, 76), Sp of 55% (95% CI 39, 69) and LR of 1.45 (95% CI 0.98, 2.15), whereas SDAI < 3.3 had an S of 57% (95% CI 44, 69), Sp of 74% (95% CI 58, 85) and LR of 2.24 (95% CI 1.25, 4.01). CONCLUSIONS Our results suggest that the SDAI classification of remission is closer to the concept of an absence of inflammatory activity, as defined by the absence of positive PD signal by US.
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Affiliation(s)
- Alejandro Balsa
- Rheumatology Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain.
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Pietrapertosa D, Salaffi F, Peluso G, Bosello SL, Fedele AL, Cuoghi I, Michelutti A, Gremese E, Ferraccioli GF. Residual minimal disease activity in rheumatoid arthritis: a simple definition through an in-depth statistical analysis of the major outcome. Rheumatology (Oxford) 2009; 48:1242-6. [PMID: 19635732 DOI: 10.1093/rheumatology/kep217] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To obtain the simplest definition of minimal disease activity (MDA) and to compare it with published proposed definitions of MDA in patients with RA. METHODS Two hundred and fourteen patients with long-standing RA (LSRA) were evaluated for clinical and laboratory parameters. Factor analysis was performed to remove redundant variables included in the core set measure for MDA definition stated by the OMERACT. Receiver operating characteristic (ROC) curves analysis allowed to obtain optimal cut-off predictors of a 28-joint disease activity score (DAS28) < or =2.85. These were tested in 112 LSRA and 95 early-onset RA (ERA) patients. RESULTS Factor and ROC curve analysis showed that the best predictors of a DAS28 < or = 2.85 in LSRA cohort were: (i) ESR <20 mm/h (sensitivity: 80%, specificity: 54%); (ii) swollen joint count (out of 28) < or =2 (sensitivity: 95%, specificity: 74%); (iii) patient global assessment (0-100) < or =15 (sensitivity: 78%, specificity: 78%); and (iv) HAQ (0-3) < or =0.5 (sensitivity: 91%, specificity: 61%). To each of these four criteria we assigned a value of 1 when it was satisfied (score ranging: 0-4). The cut-off with the highest overall accuracy for identifying RA patients with DAS28 < or = 2.85 was a score > or =3. We adopted these four parameters in order to define the residual MDA (RMDA). Comparing RMDA criteria, in distinct 112 LSRA and 95 ERA patients, with OMERACT, Simplified Disease Activity Index and Clinical Disease Activity Index definitions of MDA, we found a good agreement in the LSRA cohort and moderate agreement in the ERA cohort. CONCLUSIONS HAQ, PaGA, SJC28 and ESR allow identification of RA patients with an RMDA. The RMDA criteria behaves similarly to OMERACT definitions, but appears more simple and feasible.
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Ometto F, Botsios C, Raffeiner B, Sfriso P, Bernardi L, Todesco S, Doria A, Punzi L. Methods used to assess remission and low disease activity in rheumatoid arthritis. Autoimmun Rev 2009; 9:161-4. [PMID: 19602456 DOI: 10.1016/j.autrev.2009.07.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Accepted: 07/07/2009] [Indexed: 11/15/2022]
Abstract
The aim of the treatment in rheumatoid arthritis (RA) is to prevent articular damage and functional loss by decreasing the activity of the disease. The overall goal is the full suppression of the activity of the disease, also called clinical remission. The most reliable indices to assess RA activity were defined by the American College of Rheumatology (ACR), the European League Against Rheumatism (EULAR) and the International League Against Rheumatism (ILAR) and are habitually used for the evaluation of remission. The Food and Drug Administration (FDA) established three increasingly restrictive categories of disease remission: complete clinical response, major clinical response, and remission. Then, OMERACT (Outcome Measures in Rheumatoid Arthritis Clinical Trials) advanced the concept of low disease activity state (LDAS) or minimal disease activity (MDA). Thus, those reported by FDA are the only criteria for remission which consider radiographic arrest of the disease. This review aims to describe the criteria for RA remission and to discuss their advantages and limitations.
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Affiliation(s)
- Francesca Ometto
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Padova, 35128 Padova, Italy
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