AB0296 The Simplified Disease Activity Index (SDAI) and Clinical Disease Activity Index (CDAI) Scores as Alternatives to the Current DAS28 Score
AB0296 The Simplified Disease Activity Index (SDAI) and Clinical Disease Activity Index (CDAI) Scores as Alternatives to the Current DAS28 Score
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DOI：
10.1136/annrheumdis-2014-eular.1658
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发表时间：
2014-06
影响因子：
27.4
通讯作者：
T.N. Somasinghe-;B. Clarke;S. Panthakalam
中科院分区：
文献类型：
--
作者：
T.N. Somasinghe-;B. Clarke;S. Panthakalam
研究背景疾病活动度评分28（DAS 28-CRP/ESR）被广泛用于评估RA患者的疾病活动度和治疗反应。简化疾病活动指数（SDAI）和临床疾病活动指数（CDAI）是评估风湿性关节炎（RA）疾病活动性的新工具。评分影响治疗选择，包括使用生物制剂。SDAI和CDAI分别是5个和4个结局参数的数值总和计算器：Swedish和压痛关节评估（使用28个关节计数）、患者和医生总体评估评分（VAS和PVAS（0 - 10））和C反应蛋白（CRP）mg/dl（对于SDAI）。目前，它们的使用主要是在试验中，而不是临床实践中。我们的假设是CDAI和SDAI与RA患者现有的DAS 28评估非常相关。我们希望确定这些评分之间缓解和高疾病活动性的相关性和一致性。我们试图确定这些新的评分工具是否可以在临床实践中作为可能的替代品。方法对162例风湿病门诊患者进行为期3个月的前瞻性研究。使用所有评分工具- CDAI、SDAI、DAS 28-ESR和DAS 28-CRP确定每例患者的疾病活动度。计算每种评分工具中4个类别（缓解/低/中度/高）的患者比例。计算每项指标的Pearson相关系数和95%置信区间，沿着列联表和Bland-Altman图，以确定评分系统与kappa统计量之间的一致性。结果女性123例，占75.9%;男性39例，占24.1%。样本组的平均年龄为62.1岁（范围为22至86岁）。CDAI和SDAI的相关性非常好（pearson = 0.99，p<0.01）。DAS 28-CRP与SDAI（pearson = 0.957，p<0.01）和CDAI（pearson = 0.948，p<0.01）强相关，而DAS 28-ESR则不太相关：SDAI（pearson = 0.921，p<0.01）和CDAI（pearson = 0.914，p<0.01）。DAS 28-CRP显示与SDAI和CDAI中度一致（Kappa = 0.51和0.48），DAS 28-ESR也显示中度一致（SDAI Kappa = 0.56; CDAI Kappa = 0.54）。一些工具的得分始终高于其他工具。尺度的极端是在工具比较中出现大多数离群值的地方。结论综合使用所有四种工具是耗时的。与DAS 28-ESR相比，DAS 28-CRP与SDAI/CDAI模式的相关性更好。每个系统之间的绝对一致性/Kappa值表明其使用不可互换，因此，应使用一种评分工具以保持一致性。尽管DAS 28-CRP和DAS 28-ESR之间存在很强的相关性，但患者在ESR测量中的得分始终较高-这可能反映了年龄人口统计学。尽管总体相关性良好，但评分之间最大的不匹配似乎是在缓解和低疾病活动性类别中。然而，在高疾病活动性中，评分之间存在强相关性，因此在重度活动性疾病患者中，CDAI/SDAI可能是合理的替代方案。参考文献简化疾病活动指数（SDAI）和临床疾病活动指数（CDAI）：对它们在类风湿性关节炎中的有用性和有效性的综述。Aletaha D，Smolen J. Clin Exp Rheumatol. 2005年9月-10月;23（5增刊39）：S100-8。鸣谢流变学;研究与开发部门-东萨塞克斯医疗保健NHS信托披露利益没有宣布DOI 10. 1136/annrheumdis-2014-eular. 1658
Background The Disease Activity Score 28 (DAS 28-CRP/ESR) is widely used in the assessment of disease activity and response to treatment in patients with RA. The Simplified Disease Activity Index (SDAI) and Clinical Disease Activity Index (CDAI) are new tools for the evaluation of disease activity in Rheumatoid arthritis (RA). The scores impact on treatments options including the use of biological agents. The SDAI and CDAI are numerical sum calculators on five and four outcome parameters respectively: Swollen and tender joint assessment (using 28-joint count), patient and physician global assessment scores (VAS and PVAS (0 - 10) and the C-reactive protein (CRP) mg/dl (for the SDAI). Currently their use has been predominantly in trials rather than clinical practice. Objectives Our hypothesis is that the CDAI and SDAI correlate very well with existing DAS28 assessment in patients with RA. We wanted to determine the correlation and agreement for remission and high disease activity between these scores. We attempted to establish whether these new scoring tools could be used as possible alternatives in clinical practice. Methods We conducted a prospective study of 162 patients in rheumatology outpatients over a three month period. Disease activity was determined for each patient using all scoring tools - CDAI, SDAI, DAS28-ESR and DAS28-CRP. The proportion of patients within four categories (remission/low/moderate/high) were calculated for each scoring tool. Pearson correlation coefficients and 95% confidence intervals were calculated for each of the measures, along with contingency tables and Bland-Altman plots for agreements between scoring systems with kappa statistics. Results Female patients accounted for 75.9% (n=123) and male patients for 24.1% (n=39). The mean age of the sample group was 62.1 (range 22 to 86). CDAI and SDAI correlate extremely well (pearson = 0.99, p<0.01). DAS28-CRP is strongly correlated with SDAI (pearson = 0.957, p<0.01) and CDAI (pearson = 0.948, p<0.01), while DAS28-ESR is less so: SDAI (pearson = 0.921, p<0.01) and CDAI (pearson = 0.914, p<0.01). DAS28-CRP shows moderate agreement with SDAI and CDAI (Kappa = 0.51 and 0.48), and DAS28-ESR also shows moderate agreement (SDAI Kappa = 0.56; CDAI Kappa = 0.54). Some tools consistently scores higher than others. The extreme end of the scales is where most of the outliers occur on comparison of the tools. Conclusions Using all four tools in combination is time consuming. DAS28-CRP correlates better with the SDAI/CDAI modalities than DAS28-ESR. The absolute agreement/kappa values between each system indicate their use is not interchangeable, therefore, one scoring tool should be used for consistency. Although there is a strong correlation between DAS28-CRP and DAS28-ESR, patients consistently score higher on the ESR measure - which may reflect the age demographic. Despite good correlation overall, the greatest mismatch between scores seems to be in remission and low disease activity categories. However, in high disease activity there is strong correlation between the scores and as such in patients with severe active disease CDAI/SDAI may be plausible alternatives. References The Simplified Disease Activity Index (SDAI) and the Clinical Disease Activity Index (CDAI): a review of their usefulness and validity in rheumatoid arthritis. Aletaha D, Smolen J. Clin Exp Rheumatol. 2005 Sep-Oct;23(5 Suppl 39):S100-8. Acknowledgements Rheumatology; Research & Development Departments - East Sussex Healthcare NHS Trust Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.1658