ACR Meeting Abstracts

ACR Meeting Abstracts

  • Home
  • Meetings Archive
    • ACR Convergence 2020
    • 2020 ACR/ARP PRSYM
    • 2019 ACR/ARP Annual Meeting
    • 2018 ACR/ARHP Annual Meeting
    • 2017 ACR/ARHP Annual Meeting
    • 2017 ACR/ARHP PRSYM
    • 2016-2009 Meetings
    • Download Abstracts
  • Keyword Index
  • Advanced Search
  • Your Favorites
    • Favorites
    • Login
    • Register
    • View and print all favorites
    • Clear all your favorites
  • Meeting Resource Center

Abstract Number: 0483

Can a Clinical Disease Activity Index Based on Patient-Reported Joint Counts (PT-CDAI) Be Used to Inform Target-Based Care in Telemedicine? An Analysis of 2 Early RA Cohort Studies

Caroline Benson1, Marie-France Valois2, Orit Schieir3, Gregory Vitone1, Aidan Tirpack1, Michelle Jones4, Louis Bessette5, Gilles Boire6, Glen Hazlewood7, Carol Hitchon8, Edward C Keystone9, Janet Pope10, Carter Thorne11, Susan Bartlett2, Clifton Bingham III12, Vivian Bykerk1 and Canadian Early Arthritis Cohort (CATCH) Investigators13, 1Hospital for Special Surgery, New York, NY, 2McGill University, Montreal, Canada, 3Canadian Early Arthritis Cohort Study, Montreal, Canada, 4Johns Hopkins Arthritis Center, Baltimore, MD, 5Laval University, Quebec, Canada, 6Universite de Sherbrooke, Sherbrooke, Canada, 7University of Calgary, Calgary, AB, Canada, 8University of Manitoba, Winnipeg, MB, Canada, 9Mount Sinai Hospital, Toronto, ON, Canada, 10Department of Medicine, University of Western Ontario, St. Joseph's Health Centre, London, ON, Canada, 11Southlake Regional Health Centre, Newmarket, ON, Canada, 12Johns Hopkins University, Baltimore, MD, 13Canadian Early Arthritis Cohort (CATCH) Study, Toronto, Canada

Meeting: ACR Convergence 2020

Keywords: Disease Activity, physical examination, rheumatoid arthritis

  • Tweet
  • Email
  • Print
Save to PDF
Session Information

Date: Friday, November 6, 2020

Session Title: RA – Diagnosis, Manifestations, & Outcomes I: Pre-Onset & Early RA (0479–0483)

Session Type: Abstract Session

Session Time: 3:00PM-3:50PM

Background/Purpose: COVID-19 mitigation strategies have forced rheumatologists to shift from in-person clinical visits to telemedicine, limiting their ability to carry out complete joint exams needed to score disease activity and provide target based-care for RA patients. The purpose of this study was to estimate agreement between the validated Clinical Disease Activity Index (CDAI), and an alternative patient-based CDAI (PT-CDAI) scored using patient-reported joint counts.

Methods: Data were from early RA patients (sx < 1 year) enrolled in 2 North American prospective cohort studies, CATCH (Canadian early ArThritis CoHort) and CATCH-US (Consortium of early ArThritis Cohorts-USA), from  Mar 2017-Jan 2020 and Jan 2015-Feb 2020 with complete data needed to calculate the MD-CDAI and PT-CDAI including concurrently measured patient (PT) and physician (MD) assessed 28-tender and 28-swollen joints counts (28-TJC/28-SJC) using a homunculus, MD and PT global assessments (NRS 0-10) and other PROs (pain, stiffness, fatigue, function and mental health) at baseline, 6- and 12-months follow up. MD-CDAI and PT-CDAI were scored by summing (28-TJC and 28-SJC, MD and PT global assessments) though the former was scored using MD assessed joint counts and the latter with PT assessed joint counts. The established CDAI cut-off of 10 was applied to both scores to classify patients in REM/LDA vs. MDA/HDA disease states. Descriptive statistics were used to summarize and compare baseline cohort characteristics. Bland-Altman plots were used to estimate agreement between the MD-CDAI and the PT-CDAI. Cohen’s Kappa was used to estimate agreement between scores at classifying patients into controlled (REM/LDA) vs. active (MDA/ HDA) disease states. Mixed-effects linear regression was used to identify potential predictors of greater discrepancies between MD-CDAI and PT-CDAI.

Results: Baseline characteristics of 358 ERA patients enrolled in CATCH and 102 ERA patients enrolled in CATCH-US are summarized in Table 1. Mean differences in PT vs. MD assessments were lower for swollen than tender joints (Figure). Both studies showed higher agreement at lower ranges of the CDAI and more spread in scores at higher ranges of the CDAI (Figure). Agreement between MD-CDAI and PT-CDAI scores were moderate to substantial at classifying patients with controlled vs. active disease (Table 2). Predictors of greater differences in MD-CDAI vs. PT-CDAI in mixed-effects linear regression were greater tender joints and worse stiffness in CATCH and tender joints, obesity and male sex in CATCH-US.

Conclusion: The newly calculated PT-CDAI had good agreement with the MD-CDAI at identifying active vs. controlled RA disease activity. Results suggested that PT-based swollen joints were more consistent with MD assessments than PT tender joint counts. Moreover, predictors of higher discrepancies between PT-CDAI and MD-CDAI may help identify patient subsets that could benefit most from more MD guided training at joint self-assessments and/or more probing questioning during a telehealth visit to confirm active synovitis. Although there are other validated PROs to assess disease activity, none directly assess joint involvement which is critical to informing treatment decisions.

Table 1. Baseline Characteristics show more are older, have higher BMI and non-articular pain and are current smokers in Canadian Cohort; more are female, younger and recruited with lower disease activity in CATCH-US.

Table 2. Comparisons of MD vs. PT Joint Counts and CDAI Scores

Figure. Agreement between Physician and Patient Assessed 28 Swollen and Tender Joint Counts and PT-CDAI vs. MD-CDAI in 2 Early RA Cohorts


Disclosure: C. Benson, None; M. Valois, None; O. Schieir, None; G. Vitone, None; A. Tirpack, None; M. Jones, None; L. Bessette, Amgen, 1, 2, 3, BMS, 1, 2, 3, Janssen, 1, 2, 3, UCB, 1, 2, 3, AbbVie, 1, 2, 3, Pfizer, 1, 2, 3, Merck, 1, 2, 3, Celgene, 1, 2, 3, Sanofi, 1, 2, 3, Lilly, 1, 2, 3, Novartis, 1, 2, 3, Gilead, 2, 6, 8; G. Boire, Amgen, 1, 2, BMS, 1, 2, 3, Celgene, 1, Merck, 1, 2, Pfizer, 1, 2, 3, Eli Lilly, 1, 2, Janssen, 1, Abbvie, 1, Novartis, 1, Sandoz, 1; G. Hazlewood, None; C. Hitchon, Pfizer, 1, UCB Canada, 1; E. Keystone, AbbVie, 2, 5, 8, Celltrion, 2, 5, 8, Eli Lilly, 2, 5, 8, Pfizer Inc, 2, 5, 8, Merck, 2, 5, 8, Sandoz, 2, 5, 8, Samsung Bioepsis, 2, 5, 8, Myriad Autoimmune, 2, 5, 8, Purapharm, 2, 5, 8, Janssen, 2, 5, 8, Sanofi-Genzyme, 2, 5, 8, Amgen, 2, 5, 8, AstraZeneca, 2, 5, 8, Bristol-Myers Squibb, 2, 5, 8, F. Hoffman-La Roche Ltd., 2, 5, 8, Genentech, 2, 5, 8, Gilead, 2, 5, 8, UCB, 2, 5, 8; J. Pope, AbbVie, 2, 5, Amgen, 5, 8, Lilly, 2, 5, 8, UCB, 2, 5, 8, Sanofi, 5, 8, Sandoz, 5, 8, Roche, 2, 5, 8, Pfizer, 5, 8, Novartis, 5, 8, Merck, 2, 5, 8, Janssen, 5, 8, Gilead Sciences, Inc., 2, 5, BMS, 2, 5, 8, Abbott, 5, Actelion, 5, AstraZeneca, 5, Bayer, 5, Boehringer Ingelheim, 5, EICOS, 5, Emerald, 5, GlaxoSmithKline, 5, Medexus, 5, Seattle Genetics, 2; C. Thorne, Abbvie, 1, 2, Amgen, 1, 2, Celgene, 1, 2, CaREBiodam, 1, Centocor, 1, Janssen, 1, Lilly, 1, Medexus/Medac, 1, 2, Merck, 1, Novartis, 1, 2, Pfizer, 1, 2, Sanofi, 1; S. Bartlett, Pfizer, 1, UCB, 1, Lily, 1, Novartis, 1, Merck, 1, Janssen, 1, Abbvie, 1; C. Bingham III, Bristol-Myers Squibb, 2, 5, 8, Genetech, 5, 8, Sanofi, 5, 8, AbbVie, 5, Eli Lilly, 5, Pfizer, 5, Gilead Sciences, Inc., 5, Regeneron, 5; V. Bykerk, Amgen, 1, BMS, 1, Gilead, 1, Sanofi-Genzyme/Regeneron, 1, Scipher, 1, Pfizer, 1, UCB, 1, NIH, 1; C. (CATCH) Investigators, Amgen, 2, Pfizer Canada, 2, Medexus Inc., 2, Eli Lilly Canada, 2, Merck Canada, 2, Sandoz Canada, Biopharmaceuticals, 2, Gilead Sciences Canada, 2, Hoffmann-LaRoche, 2, Janssen Biotech, 2, UCB Canada, 2, Bristol-Myers Squibb Canada, 2, Sanofi Genzyme, 2, AbbVie Corporation, 2.

To cite this abstract in AMA style:

Benson C, Valois M, Schieir O, Vitone G, Tirpack A, Jones M, Bessette L, Boire G, Hazlewood G, Hitchon C, Keystone E, Pope J, Thorne C, Bartlett S, Bingham III C, Bykerk V, (CATCH) Investigators C. Can a Clinical Disease Activity Index Based on Patient-Reported Joint Counts (PT-CDAI) Be Used to Inform Target-Based Care in Telemedicine? An Analysis of 2 Early RA Cohort Studies [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/can-a-clinical-disease-activity-index-based-on-patient-reported-joint-counts-pt-cdai-be-used-to-inform-target-based-care-in-telemedicine-an-analysis-of-2-early-ra-cohort-studies/. Accessed January 25, 2021.
  • Tweet
  • Email
  • Print
Save to PDF

« Back to ACR Convergence 2020

ACR Meeting Abstracts - https://acrabstracts.org/abstract/can-a-clinical-disease-activity-index-based-on-patient-reported-joint-counts-pt-cdai-be-used-to-inform-target-based-care-in-telemedicine-an-analysis-of-2-early-ra-cohort-studies/

Advanced Search

Your Favorites

You can save and print a list of your favorite abstracts by clicking the “Favorite” button at the bottom of any abstract. View your favorites »

ACR Convergence: Where Rheumatology Meets. All Virtual. November 5-9.

ACR Pediatric Rheumatology Symposium 2020

© COPYRIGHT 2021 AMERICAN COLLEGE OF RHEUMATOLOGY

Wiley

  • Home
  • Meetings Archive
  • Advanced Search
  • Meeting Resource Center
  • Online Journal
  • Privacy Policy
  • Permissions Policies
loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.
This site uses cookies: Find out more.