Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: To investigate the influence of age on the components of the 28-joint Disease Activity Score (DAS28)-C-reactive protein (CRP) in patients with rheumatoid arthritis (RA) and whether DAS28-CRP can be equally interpreted in all age groups.
Methods: For RA subjects enrolled in the University of Pittsburgh Rheumatoid Arthritis Comparative Effectiveness Registry (RACER), a cross-sectional analysis was performed. The share was expressed as a proportion and calculated by dividing the formula the DAS28 by the entire DAS28 (CRP share = [0.36 x ln(CRP +1] / DAS28, Relative of the contribution of the patient reported measures (tender joint count [TJC] and patient global assessment [PtGA] in DAS28-CRP [DAS-P] = [0.56 x sqrt (TJC) + 0.014 x PtGA] / DAS28-CRP). Share of CRP and patient reported components of the DAS28 (DAS-P) were analyzed and compared between 2 age groups (younger RA <60, older RA ¡Ã 60) using Mann-Whitney U test. Inflammatory disease burden in the joint was calculated by modified DAS28 (MDAS28 = 0.49 x ln(C-reactive protein (CRP)) + 0.15 x swollen joint count 28 (SJC) + 0.22 x physician global assessment (PhGA) +1). Multivariate analyses were used to design models best predicting the effect of age on CRP, the share of CRP, inflammation level calculated by MDAS28, DAS-P, and pain levels.
Results: CRP and the share of CRP in DAS28-CRP were not influenced by age. MDAS28 did not increase significantly with age but was associated with disease duration and anti-tumor necrosis factor (TNF) therapy. Female gender had significantly higher DAS-P, while age was associated with lower DAS-P. Pain level had significant negative association with age (Table 1). In subjects with moderate inflammation (defined by MDAS28 score above 50 percentile, N=370), older RA subjects (age >= 60, N=189) had lower pain level, tender joint count (TJC), patient and physician global assessment, DAS28-CRP than younger subjects (age < 60, n=157) (Table 2).
Conclusion: CRP, CRP share, and MDAS28 were not associated with age. However, age played a role in how subjective components of DAS28-CRP and pain level are assessed and rated in patients with RA. Disease activity could be underestimated by DAS28-CRP in older RA patients with moderate to high grade inflammation from RA.
To cite this abstract in AMA style:Hwang YG, Feng J, Eng H, Lyons J, Fabio A, Moreland LW. Lower Ratings of Pain Intensity in Older Adults Lead to Underestimation of Disease Activity By Disease Activity Score 28-C-Reactive Protein (DAS28-CRP) in Patients with Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/lower-ratings-of-pain-intensity-in-older-adults-lead-to-underestimation-of-disease-activity-by-disease-activity-score-28-c-reactive-protein-das28-crp-in-patients-with-rheumatoid-arthritis/. Accessed January 24, 2020.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/lower-ratings-of-pain-intensity-in-older-adults-lead-to-underestimation-of-disease-activity-by-disease-activity-score-28-c-reactive-protein-das28-crp-in-patients-with-rheumatoid-arthritis/