Discrepancies in categorizing rheumatoid arthritis patients by DAS-28(ESR) and DAS-28(CRP): can they be reduced?
Discrepancies in categorizing rheumatoid arthritis patients by DAS-28(ESR) and DAS-28(CRP): can they be reduced?
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DOI：
10.1093/rheumatology/keq117
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发表时间：
2010-08-01
期刊：
影响因子：
5.5
通讯作者：
Conaghan, Philip G.
中科院分区：
文献类型：
--
作者：
Hensor, Elizabeth M. A.;Emery, Paul;Conaghan, Philip G.
方法。数据来自登记的早期（n = 520）和已确诊的RA （n = 364）患者。在早期队列中评估基线和6个月时疾病活动水平（缓解、低、中、高）的一致性，以及6个月时EULAR应答状态。两种可选的DAS-28（CRP）定义，通过对早期RA患者基线的线性回归分析获得，并通过两个队列的6个月数据进行验证。在早期RA患者中，尽管DAS-28分类的精确一致性很高（88.2%），但125例基线时“中度”DAS-28（CRP）患者中有38例（30.4%）具有“高”DAS-28（ESR）。通过修改DAS-28（CRP）定义，并纳入年龄和性别，这一共识得到了改进：例如，在原始DAS-28（CRP）中度的早期RA患者中，30.4%的患者DAS-28（ESR）“高”，而3.2%的患者DAS-28（ESR）“低”；DAS-28（CRP）转化后，两者的比例均为6.6%。纳入年龄和性别并不能提高对EULAR反应状态的一致性。DAS-28（ESR）和DAS-28（CRP）的定义在将RA患者划分为中度或高度疾病活动性方面存在很大差异，ESR的定义导致更高比例的高DAS-28，尤其是女性。我们的研究结果表明，修改DAS-28（CRP）的定义可能会提高与DAS-28（ESR）的一致性。这对meta分析和由DAS评分驱动的治疗有重要的意义。
Methods. Data were obtained from registers of early (n = 520) and established RA (n = 364) patients. Agreement over disease activity levels (remission, low, moderate and high) at baseline and 6 months, and EULAR responder status at 6 months, were assessed in the early cohort. Two alternative DAS-28(CRP) definitions, obtained through linear regression analyses at baseline in the early RA patients, were validated with 6-month data from both the cohorts.Results. In early RA patients, despite a high percentage of exact agreement over DAS-28 categories (88.2%), 38 (30.4%) of 125 patients with 'moderate' DAS-28(CRP) at baseline had 'high' DAS-28(ESR). This agreement was improved by modifying the DAS-28(CRP) definition, and by incorporating age and gender: e.g. in early RA patients with moderate original DAS-28(CRP), 30.4% had 'high' DAS-28(ESR), whereas 3.2% had 'low' DAS-28(ESR); following DAS-28(CRP) transformation both proportions were 6.6%. Incorporating age and gender did not improve agreement over EULAR response states.Conclusion. The DAS-28(ESR) and DAS-28(CRP) definitions differ substantially in classifying RA patients as having moderate or high disease activity, with the ESR definition resulting in a higher proportion of high DAS-28 especially in women. Our results suggest that modifying the DAS-28(CRP) definition may improve agreement with DAS-28(ESR). There are important implications for meta-analyses and for therapy driven by DAS scores.