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Abstract Number: 1731

Development of a Disease Activity Index for Rheumatoid Arthritis Patients Using the HandScan

Maxime Verhoeven1, Paco Welsing1, Janneke Tekstra1, Jacob van Laar1, Floris Lafeber1, Johannes Jacobs1 and Anton Westgeest2, 1UMC Utrecht, Utrecht, Netherlands, 2Máxima MC Eindhoven, Eindhoven, Netherlands

Meeting: ACR Convergence 2020

Keywords: Disease Activity, Imaging, Outcome measures, rheumatoid arthritis

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Session Information

Date: Monday, November 9, 2020

Title: RA – Diagnosis, Manifestations, & Outcomes Poster IV: Lifespan of a Disease

Session Type: Poster Session D

Session Time: 9:00AM-11:00AM

Background/Purpose: Disease activity in rheumatoid arthritis (RA) patients is usually measured by an index like DAS28,1 a composite measure consisting of 28 swollen and/or tender joint counts (SJC28/TJC28), an acute phase reactant (APR, e.g. ESR/CRP) and patient’s general health, typically using a visual analogue scale (VAS). Particularly assessment of joint counts is time consuming, requires a trained health professional and its inter-observer variety is high. The HandScan is developed to measure inflammation in hand joints using optical spectral transmission (OST, score 0-66) within 5 minutes, without taking time of a health professional.2 The correlation between DAS28 and a single measurement of OST is moderate.3 We hypothesised that a composite measure consisting of OST (representing joint inflammation), VAS and APR would lead to an appropriate disease activity index.

Objective:

To develop and validate a composite disease activity index for assessing RA patients using OST values obtained by the HandScan.

Methods: At a single Rheumatology centre routinely using the Handscan, RA patients with at least one concurrent OST-score and DAS28 measurement were included. Data was extracted from medical records. A random sample of 2/3 of the patients was used as development cohort, the remaining 1/3 was used as validation cohort. In the development cohort, linear regression analyses with DAS28 as outcome were performed to create a disease activity index (DAS-OST). In these analyses, OST-score, ESR and VAS, as well as gender, age, disease duration and RF-status, were evaluated as predictor variables. A final model was derived, based on statistical significance and model fit. Patients were classified as being in DAS28 based remission, low and high disease activity by DAS-OST using the established DAS28 cut-offs. In the validation cohort, agreement of DAS28 and DAS-OST was estimated with a two-way mixed effect intra-class correlation coefficient (ICC) and the measurement error was estimated using the Bland and Altman method. Diagnostic accuracy were determined for DAS-OST using the cut-offs as defined above for all disease activity states.

Results: Data of 3358 observations within 1505 unique RA patients were extracted. Patients’ demographic and clinical data are shown in Table 1.

The formula for DAS-OST derived in the development cohort was: -0.44 + OST*0.03 + male*-0.11 + LN(ESR)*0.77 + VAS*0.03.

In the validation cohort, the explained variance of DAS-OST was 78%. For agreement, the ICC was 0.88 (95%CI 0.87-0.90) and the measurement error was 0.58. Diagnostic accuracy of DAS-OST for DAS28 based remission, LDA and HDA remission is shown in Table 2.

Conclusion: Using the HandScan, disease activity can be accurately estimated in RA patients, when its score is combined with ESR, VAS and gender into an objective disease activity index (DAS-OST).


Disclosure: M. Verhoeven, None; P. Welsing, None; J. Tekstra, None; J. van Laar, MSD, 1, Astra Zeneca, 1, Roche, 1, 2, Leadiant, 1, Sanofi Genzyme, 1, Eli Lilly, 1, Gesyntha, 1, Arxx Tx, 1; F. Lafeber, None; J. Jacobs, Roche, 1; A. Westgeest, None.

To cite this abstract in AMA style:

Verhoeven M, Welsing P, Tekstra J, van Laar J, Lafeber F, Jacobs J, Westgeest A. Development of a Disease Activity Index for Rheumatoid Arthritis Patients Using the HandScan [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/development-of-a-disease-activity-index-for-rheumatoid-arthritis-patients-using-the-handscan/. Accessed .
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