Acute phase reactants add little to composite disease activity indices for rheumatoid arthritis: validation of a clinical activity score.
Acute phase reactants add little to composite disease activity indices for rheumatoid arthritis: validation of a clinical activity score.
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DOI：
10.1186/ar1740
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发表时间：
2005
影响因子：
4.9
通讯作者：
Smolen JS
中科院分区：
文献类型：
--
作者：
Aletaha D;Nell VP;Stamm T;Uffmann M;Pflugbeil S;Machold K;Smolen JS
频繁评估类风湿性关节炎（RA）疾病活动性可以及时调整治疗，这对预防疾病进展至关重要。然而，需要急性期反应物（APR）的值来计算当前的复合活动指数，诸如疾病活动性评分（DAS）28、DAS 28-CRP（即，使用C-反应蛋白代替红细胞沉降率的DAS 28）和简化疾病活动指数（SDAI）。我们假设APR对SDAI的贡献有限，并且SDAI修改消除APR-称为临床疾病活动指数（CDAI;即压痛和肿胀关节计数[28个关节]以及患者和医生总体评估[cm]的总和）-在临床队列中具有相当的有效性。数据来源包括767例RA患者（平均病程8.1 ± 10.6年）的观察性队列和106例前瞻性随访患者（病程11.5 ± 12.5周）的独立起始队列。我们基于临床的假设得到了统计学支持：APR仅占DAS 28的15%，占SDAI和DAS 28-CRP的5%。在两个队列中，CDAI与DAS 28（R = 0.89-0.90）和SDAI与DAS 28（R = 0.90-0.91）的相关性密切相关。在其他分析中，CDAI与SDAI和DAS 28相比，加权kappa值分别为0.70和0.79，与DAS 28和DAS 28-CRP之间的一致性一致。所有三个分数与健康评估问卷（HAQ）分数相关性相似（R = 0.45-0.47）。美国流变学学会反应较好的患者，所有评分的平均变化较大（P < 0.0001，方差分析;判别效度）。所有评分与3年内放射学进展（结构效度）的相关性相似（R = 0.54-0.58; P < 0.0001）。在SDAI中包含的临床变量组合之上（和独立），APR几乎没有添加信息。纯粹的临床评分是疾病活动性的有效衡量标准，在临床实践中而不是在研究中具有最大的优点，在研究中，APR通常总是可用的。CDAI可以促进即时和一致的治疗决策，并有助于改善患者的长期结局。
Frequent assessments of rheumatoid arthritis (RA) disease activity allow timely adaptation of therapy, which is essential in preventing disease progression. However, values of acute phase reactants (APRs) are needed to calculate current composite activity indices, such as the Disease Activity Score (DAS)28, the DAS28-CRP (i.e. the DAS28 using C-reactive protein instead of erythrocyte sedimentation rate) and the Simplified Disease Activity Index (SDAI). We hypothesized that APRs make limited contribution to the SDAI, and that an SDAI-modification eliminating APRs – termed the Clinical Disease Activity Index (CDAI; i.e. the sum of tender and swollen joint counts [28 joints] and patient and physician global assessments [in cm]) – would have comparable validity in clinical cohorts. Data sources comprised an observational cohort of 767 RA patients (average disease duration 8.1 ± 10.6 years), and an independent inception cohort of 106 patients (disease duration 11.5 ± 12.5 weeks) who were followed prospectively. Our clinically based hypothesis was statistically supported: APRs accounted only for 15% of the DAS28, and for 5% of the SDAI and the DAS28-CRP. In both cohorts the CDAI correlated strongly with DAS28 (R = 0.89–0.90) and comparably to the correlation of SDAI with DAS28 (R = 0.90–0.91). In additional analyses, the CDAI when compared to the SDAI and the DAS28 agreed with a weighted kappa of 0.70 and 0.79, respectively, and comparably to the agreement between DAS28 and DAS28-CRP. All three scores correlated similarly with Health Assessment Questionnaire (HAQ) scores (R = 0.45–0.47). The average changes in all scores were greater in patients with better American College of Rheumatology response (P < 0.0001, analysis of variance; discriminant validity). All scores exhibited similar correlations with radiological progression (construct validity) over 3 years (R = 0.54–0.58; P < 0.0001). APRs add little information on top (and independent) of the combination of clinical variables included in the SDAI. A purely clinical score is a valid measure of disease activity and will have its greatest merits in clinical practice rather than research, where APRs are usually always available. The CDAI may facilitate immediate and consistent treatment decisions and help to improve patient outcomes in the longer term.
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影响因子：
3
作者：
KAZIS, LE;ANDERSON, JJ;MEENAN, RF
通讯作者：
MEENAN, RF
影响因子：
27.4
作者：
LEIGH, JP;FRIES, JF
通讯作者：
FRIES, JF
影响因子：
168.9
作者：
Klareskog, L;van der Heijde, D;Sanda, M
通讯作者：
Sanda, M
影响因子：
--
作者：
FUCHS, HA;PINCUS, T
通讯作者：
PINCUS, T
DOI：
10.1002/art.10513
发表时间：
2002-08-15
期刊：
ARTHRITIS & RHEUMATISM-ARTHRITIS CARE & RESEARCH
影响因子：
--
作者：
Drossaers-Bakker, KW;Zwinderman, AH;Hazes, JMW
通讯作者：
Hazes, JMW