Analysis of the Factors That Contribute to the Differences Between DAS28-ESR and DAS28-CRP

Toshihiro Matsui¹, Hirotaka Tsuno², Jinju Nishino³, Yoshiaki Kuga⁴, Atsushi Hashimoto⁵ and Shigeto Tohma⁶, ¹Department of Rheumatology, Sagamihara Hospital, National Hospital Organization, Kanagawa, Japan, ²Department of Rheumatology, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara Hospital, Kanagawa, Japan, ³Nishino Clinic, Orthopedics and Rheumatology, Tokyo, Japan, ⁴Wakaba Hospital, Saitama, Japan, ⁵Department of Rheumatology, National Hospital Organization Sagamihara Hospital, Kanagawa, Japan, ⁶Clinical Research Center for Allergy and Rheumatology, Sagamihara Hospital, National Hospital Organization, Sagamihara, Japan

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: body mass, Disease Activity, remission and sex bias

Session Information

Title: Rheumatoid Arthritis-Clinical Aspects III: Outcome Measures, Socioeconomy, Screening, Biomarkers in Rheumatoid Arthritis

Session Type: Abstract Submissions (ACR)

Background/Purpose: It is widely accepted that the remission rate of DAS28-CRP is larger than that of DAS28-ESR, SDAI, and CDAI in patients with rheumatoid arthritis. DAS28-CRP was introduced to be comparable to DAS28-ESR and the same cut-off values of disease activity category were generally used for both DAS28. However, it had been reported that DAS28-CRP underestimates the disease activity compared with DAS28-ESR (Matsui T, et al. Ann Rheum Dis 2007;66:1221) and that the differences between DAS28-ESR and DAS28-CRP (DAS28DIF) were affected by gender and disease duration (Castrejon I, et al. Clin Exp Rheumatol 2008;26:769). It is very important to know the factors which affect DAS28DIF for evaluating the data by DAS28-CRP.The purpose of this study is to analyze the factors which have an influence on DAS28DIF.

Methods: We analyzed the data from 5987 patients with rheumatoid arthritis (RA) registered in NinJa (National Database of Rheumatic Diseases by iR-net in Japan) 2011. The mean age was 63.1±12.9 years old, disease duration was 12.1±10.8 years, and 80.7% of the patients were female. The mean DAS28-ESR and DAS28-CRP was 3.24±1.28 and 2.58±1.10, respectively (mean DAS28DIF=0.659). Multivariate linear regression analyses were conducted. Variables that were significant at p<0.01 on the univariate analysis were entered into the multivariate model.

Results: A univatiate analysis showed that several variables (gender, age, disease duration, stage, class, mHAQ, ESR, CRP, PtPainVAS, PtGVAS, DrVAS, artificial joint, TJC28, SJC28) were associated with DAS28DIF with p<0.01. A multivariate linear regression analysis demonstrated that ESR (standard partial regression coefficient :0.633), female gender (0.194), age (0.119), mHAQ (-0.087), and BMI (-0.037) were associated with DAS28DIF (coefficient of determination:0.474). Category analysis also revealed that value of DAS28DIF was significantly higher with increasing ESR, age, disease duration, class, mHAQ, DAS28-ESR, DAS28-CRP, and with decreasing BMI (Jonckheere-Tepstra trend test, p<0.001). There was significant difference in DAS28DIF between male (0.41) and female (0.72) (Wilcoxon signed-rank test, p<0.001). Mean DAS28DIF was -0.002 in patients whose ESR was 11 mm/hr or less. Cut-off value for DAS28-CRP calculated by regression analysis between DAS28-ESR and DAS28-CRP was 2.1 for remission, 2.5 for low disease activity and 4.0 for high disease activity, respectively.

Conclusion: This study showed that DAS28DIF can be affected by many kinds of valuables. We should pay attention to the background of the patients when analyzing the data by using DAS28-CRP and evaluating the cut-off value of remission for DAS28-CRP based on that of DAS28-ESR.

Disclosure:

T. Matsui,
None;

H. Tsuno,
None;

J. Nishino,
None;

Y. Kuga,
None;

A. Hashimoto,
None;

S. Tohma,
None.

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