Background/Purpose

Our aims were to assess disease activity states using DAS28ESR, CDAI and SDAI and to compare their outcomes in two rheumatoid arthritis (RA) populations of METEOR database.

Methods

A total of 24605 visits from 5870 Dutch patients and 20120 visits from 3185 Portuguese patients were analyzed. We also selected and replicated the same analyses in a subset of one random visit per patient. K-statistics and z-tests were applied to assess agreement and differences between groups. The relative contribution of each RA core set measure was determined for the three indices.   

Results

We found significant differences in the distribution of RA disease activity states between Dutch and Portuguese populations when DAS28ESR was used. SDAI and CDAI attenuated those differences. The percentage of Dutch and Portuguese visits classified as “in remission” was very similar with CDAI, SDAI and ACR/EULAR remission criteria. Contrary, using DAS28ESR, a significant higher proportion of Dutch visits was classified in remission. ESR was lower in Dutch visits and this component was determinant for lowering DAS28 scores in this group of patients.

Conclusion

CDAI and SDAI assigned distinct RA activity states when compared to DAS28 in our two populations from METEOR database. Table – Comparing means of the components of the disease activity indices within each disease activity state between Dutch and Portuguese populations

A. DAS28 original
	Remission		Low		Moderate		High
	z	p-value	Z	p-value	z	p-value	z	p-value
PGA	6.73	<0.0001	4.49	<0.0001	8.39	<0.0001	5.82	<0.0001
TJC28	6.24	<0.0001	6.84	<0.0001	-2.61	0.0090	-13.61	<0.0001
SJC28	3.65	0.0003	1.94	0.0520	-0.88	0.3791	-5.32	<0.0001
ESR	-14.33	<0.0001	-9.59	<0.0001	-13.41	<0.0001	-3.57	0.0004
DAS28	-7.34	<0.0001	-0.49	0.6245	-7.94	<0.0001	-10.44	<0.0001
B. CDAI
	Remission		Low		Moderate		High
	z	p-value	z	p-value	z	p-value	z	p-value
PGA	1.99	0.0465	-3.71	0.0002	4.64	<0.0001	4.40	<0.0001
MDGA	10.63	<0.0001	11.84	<0.0001	10.4	<0.0001	7.75	<0.0001
TJC28	1.37	0.1713	-3.38	0.0007	-7.95	<0.0001	-11.06	<0.0001
SJC28	-4.59	<0.0001	-4.26	<0.0001	-6.11	<0.0001	-5.99	<0.0001
CDAI	5.87	<0.0001	-0.85	0.3949	-2.85	0.0044	-8.76	<0.0001
C. SDAI
	Remission		Low		Moderate		High
	z	p-value	z	p-value	z	p-value	z	p-value
PGA	-3.56	0.0004	-1.77	0.0763	4.52	<0.0001	1.67	0.0955
MDGA	3.66	0.0003	9.13	<0.0001	13.58	<0.0001	6.79	<0.0001
TJC28	1.90	0.0575	0.06	0.9515	-0.31	0.7548	-2.37	0.0179
SJC28	-1.91	0.0555	-3.39	0.0007	-5.78	<0.0001	-3.52	0.0004
CRP	-1.54	0.1232	-2.4	0.0162	-7.27	<0.0001	-1.62	0.1050
SDAI	-0.86	0.3912	1.31	0.19	1.22	0.2233	-2.94	0.0033

Visits = Number of visits (%)     PGA = Patient assessment of disease activity               (100mm)                      TJC28 = 28 tender joint count

SJC28 = 28 swollen joint count                  MDGA = Physician assessment of disease activity (100mm)          CRP = C-reactive protein (mg/l)

ESR = Erythrocyte sedimentation rate (mm/h)              DAS28 = Disease activity score evaluating 28 joints

CDAI = Clinical disease activity index                         SDAI = Simplified disease activity index

z = z-test for equality of two independent means (z>0 if the mean for Dutch group is higher than for Portuguese group)

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/comparative-study-of-rheumatoid-arthritis-disease-activity-indices-in-two-populations-of-meteor-database/