Identification of disease activity and health status cut-off points for the symptom state acceptable to patients with rheumatoid arthritis
Identification of disease activity and health status cut-off points for the symptom state acceptable to patients with rheumatoid arthritis
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DOI：
10.1136/ard.2007.077503
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发表时间：
2008-07-01
影响因子：
27.4
通讯作者：
Hagen, K. B.
中科院分区：
文献类型：
--
作者：
Heiberg, T.;Kvien, T. K.;Hagen, K. B.
背景资料：需要从患者的角度对低水平疾病活动的既定阈值进行检查。目的：确定患者对病情满意度的新分界点（患者可接受的症状状态（PASS）），并检查复合指数的新PASS截止点与现有缓解阈值之间的一致性，低度和中度疾病活动。方法：类风湿性关节炎患者的治疗登记（n= 1496，72.1%女性，平均（SD）年龄53.9（13.5）年，病程7.6（9.1）岁，28关节疾病活动评分（DAS 28）4.98（1.36））在随访期间（12、24和52周）回答了关于满意状况（PASS）的总体二分问题。通过第75百分位数估计和受试者操作特征分析确定了新的PASS截止点，并检查了复合指数的截止点与低疾病活动阈值的一致性（1.625）的患者活动量表（PAS）和DAS中缓解、低和中度疾病活动的阈值28，结果：DAS 28、SDAI和CDAI的新PASS分界点均在疾病活动的中等范围内，PAS的分界点为3.56。疾病活动水平阈值和PASS截止点之间的协议是最好的低疾病活动（准确度64.5-74.6），和更好的中度疾病活动（准确度61.3-67.2）比缓解（准确度30.7-45.8）。结论：目前的PASS概念似乎是在中度疾病活动的范围内。
Background: Established thresholds for low levels of disease activity need to be examined from a patients' perspective.Objective: To identify new cut-off points for patients' perception of satisfactory condition (patient acceptable symptom state (PASS)) in composite indices and patient-reported outcomes, and to examine the agreement between the new PASS cut-off points for composite indices and existing thresholds for remission, low and moderate disease activity.Methods: Patients with rheumatoid arthritis from a treatment register (n= 1496, 72.1% women, mean (SD) age 53.9 (13.5) years, disease duration 7.6 (9.1) years, 28-joint Disease Activity Score (DAS28) 4.98 (1.36)) responded during follow-up (12, 24 and 52 weeks) to a global dichotomised question on satisfactory condition (PASS). New PASS cut-off points were identified with the 75th centile estimation and receiver operating characteristic analyses for a variety of outcome measures, and cutoff points for composite indices were examined for agreement with the low disease activity threshold (1.625) of the Patient Activity Scale (PAS) and thresholds for remission, low and moderate disease activity in DAS28, Simplified Disease Activity Index (SDAI) and Clinical Disease Activity Index (CDAI).Results: New PASS cut-off points for DAS28, SDAI and CDAI were in the moderate range of disease activity, and the cut-off point was 3.56 for PAS. Agreement between thresholds for disease activity levels and the PASS cut-off points was best for low disease activity (accuracy 64.5-74.6), and better for moderate disease activity (accuracy 61.3-67.2) than for remission (accuracy 30.7-45.8).Conclusion: The current PASS concept seems to be in the range of moderate disease activity.