Session Information
Session Title: Rheumatoid Arthritis - Clinical Aspects (ACR): Impact of Various Interventions and Therapeutic Approaches
Session Type: Abstract Submissions (ACR)
Background/Purpose: Composite indices and single items are available to monitor disease activity in rheumatoid arthritis (RA). Their relation to radiographic progression is an important aspect to select the most appropriate as target. The objective of this study was to investigate the relationship between different disease activity indices (DAIs) and their individual components and radiographic progression in patients with RA.
Methods: A systematic literature review until July 2013 was performed by two independent reviewers using Medline and EMBASE databases. The research question was formulated according to the PICO method: Population (RA patients); Intervention (DAI including DAS, DAS28, SDAI, CDAI, RADAI and RAPID and individual items or scales including patientxs global health (GH), patientxs global disease activity, pain, evaluatorxs global disease activity (EGA), all on a VAS, CRP, ESR, SJC and TJC); Outcome (radiographic progression). Longitudinal studies with ≥ 12 months of follow up assessing the relation between DAIs and single items and radiographic progression were included. Risk of bias of the studies was evaluated according to Hayden tool (range 1-6). The results were grouped based on the means of measuring (baseline versus time-integrated) and analysis (univariable or multivariable).
Results: Fifty five studies from 1232 citations were included. Most of the studies were prospective cohorts and had an overall quality score ≥ 4 points. Radiographic progression was mainly assessed using the modified Sharp van der Heijde or Larsen scoring methods and the period to evaluate progression ranged between 12 and 240 months. The table shows a summary of the studies included in the SLR. All published studies that assessed the relationship between any time-integrated DAI and radiographic progression reached a statistically significant association. Among the single items, only SJC and ESR were associated with radiographic progression, while no significant association was found for TJC. Data with respect to CRP is conflicting. Data on patientxs GH, pain assessment and EGA is limited and does not support a positive association with progression of joint damage.
Conclusion: Published data indicates that composite disease activity scores including swollen joints are more related to radiographic progression than their individual components. Therefore, these are the optimal tools to monitor disease activity in patients with RA. The best performing single items are SJC and ESR.
Table: Summary of studies evaluating the relationship between disease activity indices and their individual components and radiographic progression; Data show total number of studies and the percentage of studies that reached statistically significance (% sig) based on the type of measure and analysis employed.
|
|
Baseline measure
|
Time-integrated measure
|
|||
|
Number of studies
|
Univariable studies n, (% sig)
|
Multivariable studies n, (% sig)
|
Univariable studies n, (% sig)
|
Multivariable studies n, (% sig)
|
|
|
Disease activity index
|
|
|
|
|
|
|
DAS |
11 |
7 (29) |
1 (100) |
– |
3 (100) |
|
DAS28 |
18 |
6 (17) |
2 (50) |
6 (100) |
4 (≥75) |
|
SDAI |
7 |
1 (100)
|
– |
5 (100) |
1 (100) |
|
CDAI |
5 |
1 (0) |
– |
3 (100) |
1(100) |
|
RADAI |
2 |
2 (50) |
– |
– |
– |
|
RAPID |
0 |
– |
– |
– |
– |
|
Item or scale
|
|
|
|
|
|
|
TJC |
24 |
16 (31) |
3 (33) |
3 (100) |
3 (0) |
|
SJC |
34 |
20 (44) |
5 (60) |
3 (100) |
6 (67) |
|
GH |
2 |
1 (0) |
1 (100) |
– |
– |
|
PGA |
4 |
2 (0) |
– |
2 (100) |
– |
|
VAS pain |
8 |
4 (25) |
2 (50) |
1 (100) |
1 (0) |
|
EGA |
7 |
5 (20) |
– |
1 (100) |
1 (100) |
|
ESR |
37 |
14 (43) |
12 (83) |
6 (100) |
5 (60) |
|
CRP |
36 |
18 (50) |
8 (63) |
6 (67) |
4 (50) |
Disclosure:
V. Navarro-Compán,
None;
A. M. Gherghe,
None;
J. Smolen,
None;
D. Aletaha,
None;
R. B. M. Landewé,
None;
D. van der Heijde,
None.
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