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Balay-Dustrude E, Shenoi S. Current Validated Clinical and Patient Reported Disease Outcome Measures in Juvenile Idiopathic Arthritis. Open Access Rheumatol 2023; 15:189-206. [PMID: 37841510 PMCID: PMC10574249 DOI: 10.2147/oarrr.s261773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/29/2023] [Indexed: 10/17/2023] Open
Abstract
Juvenile idiopathic arthritis (JIA) is a common chronic illness in childhood and comprises seven categories based on the International League of Associations for Rheumatology (ILAR) criteria. Accurate assessment and measurement of the clinical, functional, and quality of life outcomes of patients with JIA are paramount for understanding the disease course and formulating effective treatment strategies. Interest in the development and use of outcome measurements specifically focused on rheumatologic conditions has greatly expanded over the last two decades, adding to and improving upon the established disease measures. Furthermore, many of these measures have been validated using the widely accepted Outcome Measures in Rheumatology (OMERACT) core principles of instrument validation, allowing researchers and clinicians to gain confidence in these tools. This review summarizes the current validated disease outcome measures in JIA, including clinical, imaging, patient-reported, and functional outcome measurement tools, and highlights ongoing work that continues to refine and improve upon the available tools. The clinical disease outcome measures discussed in this review include physician global assessment (PhGA), American College of Rheumatology (ACR, Wallace) criteria for clinical inactive disease and clinical remission, juvenile arthritis disease activity scores (JADAS), juvenile spondyloarthritis disease activity index (JSPaDA), juvenile arthritis damage index (JADAI), and the ACR pediatric response scores. The imaging outcome measures discussed include the Dijkstra composite scores, childhood arthritis radiographic score of the hip (CARSH), and Poznanski Score. The patient-reported disease outcome measures discussed include patient global assessment (PtGA), patient-reported outcome measurement information system for JIA (PROMIS), juvenile arthritis parent/child centered disease assessment index (JAPAI, JACAI), juvenile arthritis multidimensional assessment report (JAMAR), and the Pediatric quality of life inventory rheumatology module (PedsQL). The functional outcome tools discussed include the Childhood Health Assessment Questionnaire (CHAQ), juvenile arthritis functionality scale and index (JAFS and JASI), and Juvenile Arthritis Functional Assessment Report and Scale (JAFAS and JAFAR).
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Affiliation(s)
- Erin Balay-Dustrude
- Department of Pediatrics, Division of Rheumatology, University of Washington, Seattle, WA, USA
- Department of Pediatric Rheumatology, Seattle Children’s Hospital and Research Center, Seattle, WA, USA
| | - Susan Shenoi
- Department of Pediatrics, Division of Rheumatology, University of Washington, Seattle, WA, USA
- Department of Pediatric Rheumatology, Seattle Children’s Hospital and Research Center, Seattle, WA, USA
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Smesam HN, Qazmooz HA, Khayoon SQ, Almulla AF, Al-Hakeim HK, Maes M. Pathway Phenotypes Underpinning Depression, Anxiety, and Chronic Fatigue Symptoms Due to Acute Rheumatoid Arthritis: A Precision Nomothetic Psychiatry Analysis. J Pers Med 2022; 12:476. [PMID: 35330475 PMCID: PMC8950237 DOI: 10.3390/jpm12030476] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/19/2022] [Accepted: 03/08/2022] [Indexed: 12/12/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory and autoimmune disorder which affects the joints in the wrists, fingers, and knees. RA is often associated with depressive and anxiety symptoms as well as chronic fatigue syndrome (CFS)-like symptoms. This paper examines the association between depressive symptoms (measured with the Beck Depression Inventory, BDI), anxiety (Hamilton Anxiety Rating Scale, HAMA), CFS-like (Fibro-fatigue Scale) symptoms and immune-inflammatory, autoimmune, and endogenous opioid system (EOS) markers, and lactosylcer-amide (CD17) in RA. The serum biomarkers were assayed in 118 RA and 50 healthy controls. Results were analyzed using the new precision nomothetic psychiatry approach. We found significant correlations between the BDI, FF, and HAMA scores and severity of RA, as assessed with the DAS28-4, clinical and disease activity indices, the number of tender and swollen joints, and patient and evaluator global assessment scores. Partial least squares analysis showed that 69.7% of the variance in this common core underpinning psychopathology and RA symptoms was explained by immune-inflammatory pathways, rheumatoid factor, anti-citrullinated protein antibodies, CD17, and mu-opioid receptor levels. We constructed a new endophenotype class comprising patients with very high immune-inflammatory markers, CD17, RA, affective and CF-like symptoms, and tobacco use disorder. We extracted a reliable and replicable latent vector (pathway phenotype) from immune data, psychopathology, and RA-severity scales. Depression, anxiety, and CFS-like symptoms due to RA are manifestations of the phenome of RA and are mediated by the effects of the same immune-inflammatory, autoimmune, and other pathways that underpin the pathophysiology of RA.
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Affiliation(s)
- Hasan Najah Smesam
- Department of Chemistry, College of Science, University of Kufa, Kufa 540011, Iraq; (H.N.S.); (H.K.A.-H.)
| | - Hasan Abbas Qazmooz
- Department of Ecology, College of Science, University of Kufa, Kufa 540011, Iraq;
| | - Sinan Qayes Khayoon
- Department of Biology, College of Science, University of Kufa, Kufa 540011, Iraq;
| | - Abbas F. Almulla
- Medical Laboratory Technology Department, College of Medical Technology, The Islamic University, Najaf 54001, Iraq;
| | - Hussein Kadhem Al-Hakeim
- Department of Chemistry, College of Science, University of Kufa, Kufa 540011, Iraq; (H.N.S.); (H.K.A.-H.)
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
- Department of Psychiatry, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, P.O. Box 281, Geelong, VIC 3220, Australia
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Alongi A, Giancane G, Naddei R, Natoli V, Ridella F, Burrone M, Rosina S, Chedeville G, Alexeeva E, Horneff G, Foeldvari I, Filocamo G, Constantin T, Ruperto N, Ravelli A, Consolaro A. Drivers of non-zero physician global scores during periods of inactive disease in juvenile idiopathic arthritis. RMD Open 2022; 8:e002042. [PMID: 35256534 PMCID: PMC8905981 DOI: 10.1136/rmdopen-2021-002042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/01/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To investigate the frequency in which the physician provides a global assessment of disease activity (PhGA) >0 and an active joint count (AJC)=0 in children with juvenile idiopathic arthritis (JIA) and search for determinants of divergence between the two measures. METHODS Data were extracted from a multinational cross-sectional dataset of 9966 patients who had JIA by International League of Associations for Rheumatology criteria, were recruited between 2011 and 2016, and had both PhGA and AJC recorded by the caring paediatric rheumatologist at the study visit. Determinants of discordance between PhGA>0 and AJC=0 were searched for by multivariable logistic regression and dominance analyses. RESULTS The PhGA was scored >0 in 1647 (32.3%) of 5103 patients who had an AJC of 0. Independent associations with discordant assessment were identified for tender or restricted joint count >0, history of enthesitis, presence of active uveitis or systemic features, enthesitis-related or systemic arthritis, increased acute phase reactants, pain visual analogue scale (VAS)>0, and impaired physical or psychosocial well-being. In dominance analysis, tender joint count accounted for 35.43% of PhGA variance, followed by pain VAS>0 (17.72%), restricted joint count >0 (16.14%) and physical health score >0 (11.42%). CONCLUSION We found that many paediatric rheumatologists did not mark a score of 0 for patients who they found not to have active joints. The presence of pain in joints not meeting the definition of active joint used in JIA was the main determinant of this phenomenon.
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Affiliation(s)
- Alessandra Alongi
- Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione Civico Di Cristina Benfratelli, Palermo, Italy
| | - Gabriella Giancane
- UOC Clinica Pediatrica e Reumatologia, Istituto Giannina Gaslini Istituto Pediatrico di Ricovero e Cura a Carattere Scientifico, Genova, Italy
| | - Roberta Naddei
- UOC Clinica Pediatrica e Reumatologia, Istituto Giannina Gaslini Istituto Pediatrico di Ricovero e Cura a Carattere Scientifico, Genova, Italy
- Department of Translational Medical Sciences, Pediatric Section, University of Naples Federico II, Napoli, Italy
| | - Valentina Natoli
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università degli Studi di Genova, Genova, Italy
| | - Francesca Ridella
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università degli Studi di Genova, Genova, Italy
| | - Marco Burrone
- Department of Pediatrics, Vittore Buzzi Children's Hospital, Università degli Studi di Milano, Milano, Italy
| | - Silvia Rosina
- UOC Clinica Pediatrica e Reumatologia, Istituto Giannina Gaslini Istituto Pediatrico di Ricovero e Cura a Carattere Scientifico, Genova, Italy
| | - Gaelle Chedeville
- Rheumatology Division, McGill University Health Center, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Ekaterina Alexeeva
- Children's Health of RAMS and IM Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Gerd Horneff
- Pediatrics, Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany
| | - Ivan Foeldvari
- Klinikum Eilbek, Hamburger Zentrum für Kinder- und Jugendrheumatologie, Hamburg, Germany
| | - Giovanni Filocamo
- UOC Pediatria Media Intesità di Cure, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Tamàs Constantin
- Unit of Paediatric Rheumatology, Semmelweis University, Budapest, Hungary
| | - Nicolino Ruperto
- Pediatria II - PRINTO, Istituto Giannina Gaslini Istituto Pediatrico di Ricovero e Cura a Carattere Scientifico, Genova, Italy
| | - Angelo Ravelli
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università degli Studi di Genova, Genova, Italy
- Direzione Scientifica, Istituto Giannina Gaslini Istituto Pediatrico di Ricovero e Cura a Carattere Scientifico, Genova, Italy
| | - Alessandro Consolaro
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università degli Studi di Genova, Genova, Italy
- UOC Clinica Pediatrica e Reumatologia, Istituto Giannina Gaslini, Genova, Italy
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Turk MA, Hayworth JL, Nevskaya T, Pope JE. Ocular Manifestations in Rheumatoid Arthritis, Connective Tissue Disease, and Vasculitis: A Systematic Review and Metaanalysis. J Rheumatol 2020; 48:25-34. [DOI: 10.3899/jrheum.190768] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2020] [Indexed: 01/09/2023]
Abstract
Objective.Rheumatoid arthritis (RA) and other rheumatic diseases may present with ocular manifestations.The purpose of our work was to determine the prevalence and type of eye involvement in RA and other connective tissue diseases through a metaanalysis and literature review.Methods.A systematic review of the literature was performed using Medline, Web of Science, and the Cochrane Library from their inceptions until January 7, 2019. Conjunctivitis, keratoconjunctivitis sicca, xeropthalmia, uveitis, eye hemorrhage, optic neuritis, papilledema, orbital disease, retinal artery/vein occlusion, macular edema, retinitis, chorioretinitis, scleritis, iridocyclitits, choroid hemorrhage, blindness, and amaurosis fugax were searched for prevalence in patients with RA, systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), dermatomyositis, polymyositis, systemic sclerosis, Sjögren syndrome (SS), undifferentiated connective tissue disease, giant cell arteritis, granulomatosis polyangiitis (GPA; formerly Wegener granulomatosis), systemic vasculitis, and sarcoidosis.Results.There were 3394 studies identified and 65 included. The prevalence of eye involvement was 18% in RA, 26% in GPA, 27% in giant cell arteritis, 27% in sarcoidosis, 31% in SLE, and 35% in APS. The most common manifestation was dry eye syndrome (“dry eye”; keratoconjunctivitis sicca) in most diseases analyzed, with an especially high frequency of 89% in SS. Anterior and posterior uveitis were the most common ocular complications in sarcoidosis, occurring in 16% (95% CI 3–28) and 6% (95% CI 3–9) of patients, respectively.Conclusion.Eye involvement is present in approximately one-fifth of patients with RA, and a one-quarter to one-third of patients with connective tissue diseases (other than SS at 89%) and vasculitis.
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Studenic P, Felson D, de Wit M, Alasti F, Stamm TA, Smolen JS, Aletaha D. Testing different thresholds for patient global assessment in defining remission for rheumatoid arthritis: are the current ACR/EULAR Boolean criteria optimal? Ann Rheum Dis 2020; 79:445-452. [PMID: 32024651 PMCID: PMC10564460 DOI: 10.1136/annrheumdis-2019-216529] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/21/2019] [Accepted: 01/22/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES This study aimed to evaluate different patient global assessment (PGA) cut-offs required in the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) Boolean remission definition for their utility in rheumatoid arthritis (RA). METHODS We used data from six randomised controlled trials in early and established RA. We increased the threshold for the 0-10 score for PGA gradually from 1 to 3 in steps of 0.5 (Boolean1.5 to Boolean3.0) and omitted PGA completely (BooleanX) at 6 and 12 months. Agreement with the index-based (Simplified Disease Activity Index (SDAI)) remission definition was analysed using kappa, recursive partitioning (classification and regression tree (CART)) and receiver operating characteristics. The impact of achieving each definition on functional and radiographic outcomes after 1 year was explored. RESULTS Data from 1680 patients with early RA and 920 patients with established RA were included. The proportion of patients achieving Boolean remission increased with higher thresholds for PGA from 12.4% to 19.7% in early and 5.9% to 12.3% in established RA at 6 months. Best agreement with SDAI remission occurred at PGA cut-offs of 1.5 and 2.0, while agreement decreased with higher PGA (CART: optimal agreement at PGA≤1.6 cm; sensitivity of PGA≤1.5 95%). Changing PGA thresholds at 6 months did not affect radiographic progression at 12 months (mean ꙙsmTSS for Boolean, 1.5, 2.0, 2.5, 3.0, BooleanX: 0.35±5.4, 0.38±5.14, 0.41±5.1, 0.37±4.9, 0.34±4.9, 0.27±4.7). However, the proportion attaining HAQ≤0.5 was 90.2%, 87.9%, 85.2%, 81.1%, 80.7% and 73.1% for the respective Boolean definitions. CONCLUSION Increasing the PGA cut-off to 1.5 cm would provide high consistency between Boolean with the index-based remission; the integer cut-off of 2.0 cm performed similarly.
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Affiliation(s)
- Paul Studenic
- Department of Internal Medicine 3, Division of Rheumatology, Medical University of Vienna, Wien, Austria
| | - David Felson
- Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts, USA
- Centre for Epidemiology, The University of Manchester, Manchester, UK
| | - Maarten de Wit
- Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), EULAR, Zurich, Switzerland
| | - Farideh Alasti
- Department of Internal Medicine 3, Division of Rheumatology, Medical University of Vienna, Wien, Austria
| | - Tanja A Stamm
- Center for Medical Statistics, Informatics, and Intelligent Systems, Section for Outcomes Research, Medical University of Vienna, Wien, Austria
| | - Josef S Smolen
- Department of Internal Medicine 3, Division of Rheumatology, Medical University of Vienna, Wien, Austria
| | - Daniel Aletaha
- Department of Internal Medicine 3, Division of Rheumatology, Medical University of Vienna, Wien, Austria
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Schwartz MN, Rimland CA, Quinn KA, Ferrada MA, Gribbons KB, Rosenblum JS, Goodspeed W, Novakovich E, Grayson PC. Utility of the Brief Illness Perception Questionnaire to Monitor Patient Beliefs in Systemic Vasculitis. J Rheumatol 2020; 47:1785-1792. [PMID: 32238516 DOI: 10.3899/jrheum.190828] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To assess the validity and clinical utility of the Brief Illness Perception Questionnaire (BIPQ) to measure illness perceptions in multiple forms of vasculitis. METHODS Patients with giant cell arteritis (GCA), Takayasu arteritis (TA), antineutrophil cytoplasmic antibody-associated vasculitis (AAV), and relapsing polychondritis (RP) were recruited into a prospective, observational cohort. Patients independently completed the BIPQ, Multidimensional Fatigue Inventory (MFI), Medical Outcomes Study 36-item Short Form survey (SF-36), and a patient global assessment (PtGA) at successive study visits. Physicians concurrently completed a physician global assessment (PGA) form. Illness perceptions, as assessed by the BIPQ, were compared to responses from the full-length Revised Illness Perception Questionnaire (IPQ-R) and to other clinical outcome measures. RESULTS There were 196 patients (GCA = 47, TA = 47, RP = 56, AAV = 46) evaluated over 454 visits. Illness perception scores in each domain were comparable between the BIPQ and IPQ-R (3.28 vs 3.47, P = 0.22). Illness perceptions differed by type of vasculitis, with the highest perceived psychological burden of disease in RP. The BIPQ was significantly associated with all other patient-reported outcome measures (rho = |0.50-0.70|, P < 0.0001), but did not correlate with PGA (rho = 0.13, P = 0.13). A change in the BIPQ composite score of ≥ 7 over successive visits was associated with concomitant change in the PtGA. Change in the MFI and BIPQ scores significantly correlated over time (rho = 0.38, P = 0.0008). CONCLUSION The BIPQ is an accurate and valid assessment tool to measure and monitor illness perceptions in patients with vasculitis. Use of the BIPQ as an outcome measure in clinical trials may provide complementary information to physician-based assessments.
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Affiliation(s)
- Mollie N Schwartz
- M.N. Schwartz, BS, M.A. Ferrada, MD, K.B. Gribbons, BS, J.S. Rosenblum, BS, W. Goodspeed, RN, E. Novakovich, RN, P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland
| | - Casey A Rimland
- C.A. Rimland, PhD, Systemic Autoimmunity Branch, NIH, NIAMS, Bethesda, Maryland, and University of North Carolina at Chapel Hill School of Medicine, Medical Scientist Training Program, Chapel Hill, North Carolina
| | - Kaitlin A Quinn
- K.A. Quinn, MD, Systemic Autoimmunity Branch, NIH, NIAMS, Bethesda, Maryland, and Division of Rheumatology, MedStar Georgetown University Hospital, Washington, D.C., USA
| | - Marcela A Ferrada
- M.N. Schwartz, BS, M.A. Ferrada, MD, K.B. Gribbons, BS, J.S. Rosenblum, BS, W. Goodspeed, RN, E. Novakovich, RN, P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland
| | - K Bates Gribbons
- M.N. Schwartz, BS, M.A. Ferrada, MD, K.B. Gribbons, BS, J.S. Rosenblum, BS, W. Goodspeed, RN, E. Novakovich, RN, P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland
| | - Joel S Rosenblum
- M.N. Schwartz, BS, M.A. Ferrada, MD, K.B. Gribbons, BS, J.S. Rosenblum, BS, W. Goodspeed, RN, E. Novakovich, RN, P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland
| | - Wendy Goodspeed
- M.N. Schwartz, BS, M.A. Ferrada, MD, K.B. Gribbons, BS, J.S. Rosenblum, BS, W. Goodspeed, RN, E. Novakovich, RN, P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland
| | - Elaine Novakovich
- M.N. Schwartz, BS, M.A. Ferrada, MD, K.B. Gribbons, BS, J.S. Rosenblum, BS, W. Goodspeed, RN, E. Novakovich, RN, P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland
| | - Peter C Grayson
- M.N. Schwartz, BS, M.A. Ferrada, MD, K.B. Gribbons, BS, J.S. Rosenblum, BS, W. Goodspeed, RN, E. Novakovich, RN, P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland;
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Aletaha D, Wang X, Zhong S, Florentinus S, Monastiriakos K, Smolen JS. Differences in disease activity measures in patients with rheumatoid arthritis who achieved DAS, SDAI, or CDAI remission but not Boolean remission. Semin Arthritis Rheum 2019; 50:276-284. [PMID: 31590930 DOI: 10.1016/j.semarthrit.2019.09.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/14/2019] [Accepted: 09/09/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES In patients with rheumatoid arthritis (RA), remission may be assessed by various composite measures. We assessed achievement of remission as defined by Boolean criteria, Simplified Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI), and 28-joint Disease Activity Score using C-reactive protein (DAS28[CRP]) and determined the components that limit patients in SDAI, CDAI, or DAS28(CRP) remission from achieving Boolean remission. METHODS The proportions of patients achieving Boolean, SDAI, CDAI, or DAS28(CRP) remission were calculated for 3 trials: PREMIER and OPTIMA in patients with early RA and DE019 in patients with established RA. At the first visit that remission was recorded during the first 52 weeks of the trial, the following were assessed: swollen/tender joint count at 28 and 66/68 joints, CRP, Patient's/Physician's Global Assessment (PGA/PhGA), SDAI, DAS28(CRP), and Health Assessment Questionnaire-Disability Index. RESULTS The majority of patients (61-66%) who achieved SDAI or CDAI remission also attained Boolean remission. Although DAS28(CRP) remission was most frequently attained, 74-77% of patients in DAS28(CRP) remission did not achieve Boolean remission. Compared with patients in Boolean remission, patients in SDAI or CDAI remission but not Boolean remission had higher PGA scores, while patients with DAS28(CRP) remission but not Boolean remission had higher joint counts, and PGA and PhGA scores. CONCLUSIONS Differences in PGA limit patients in SDAI/CDAI remission from meeting the Boolean remission criteria, suggesting that these criteria otherwise can be used interchangeably. In contrast, patients in DAS28(CRP) remission are limited by differences in multiple disease activity measures from achieving Boolean remission.
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Affiliation(s)
- Daniel Aletaha
- Medical University of Vienna, Waehringer, Guertel 18-20, A-1090, Vienna, Austria.
| | - Xin Wang
- AbbVie Inc., 1 North Waukegan Road, North Chicago, IL, 60064, USA.
| | - Sheng Zhong
- AbbVie Inc., 1 North Waukegan Road, North Chicago, IL, 60064, USA.
| | | | | | - Josef S Smolen
- Medical University of Vienna, Waehringer, Guertel 18-20, A-1090, Vienna, Austria.
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Pope JE, Michaud K. Is It Time to Banish Composite Measures for Remission in Rheumatoid Arthritis? Arthritis Care Res (Hoboken) 2019; 71:1300-1303. [DOI: 10.1002/acr.23862] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 02/26/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Janet E. Pope
- Schulich School of Medicine and Dentistry University of Western Ontario, and St. Joseph's Health Care London Ontario Canada
| | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, and FORWARD, The National Databank for Rheumatic Diseases Wichita Kansas
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