Open AccessA Proposal to Standardize Low Disease Activity Criteria in Rheumatoid Arthritis Based on the Outcome Measures in Rheumatology Minimal Disease Activity Definition
Author(s) -
Yokogawa Naoto,
Shimada Kota,
Sugii Shoji,
Komiya Akiko,
Matsui Toshihiro,
Nishino Jinju,
Tohma Shigeto
Publication year - 2020
Publication title -
acr open rheumatology
Language(s) - English
Resource type - Journals
ISSN - 2578-5745
DOI - 10.1002/acr2.11142
Subject(s) - medicine , rheumatoid arthritis , rheumatology , erythrocyte sedimentation rate , cutoff , receiver operating characteristic , disease , patient reported outcome , physical therapy , clinical disease , quality of life (healthcare) , physics , nursing , quantum mechanics
Objective We aimed to standardize the definition of low disease activity in rheumatoid arthritis ( RA ) using the Outcome Measures in Rheumatology ( OMERACT ) group's proposed definition of minimal disease activity. Method Based on a nationwide RA database, we proposed new Boolean low disease activity criteria using OMERACT 's core set definition of minimal disease activity that requires the fulfillment of at least five of the following seven core set measures: a pain score of 2 or less, a swollen joint count ( SJC 28) of 1 or fewer, a tender joint count of 1 or fewer, a Health Assessment Questionnaire score of 0.5 or less, a Physician's Global Assessment score of 1.5 or less, a Patient's Global Assessment score of 2 or less, and an erythrocyte sedimentation rate ( ESR ) of 20 mm/h or less. Using receiver operating characteristic analysis, we determined the cutoffs for the Simplified Disease Activity Index ( SDAI ), Clinical Disease Activity Index ( CDAI ), Routine Assessment of Patient Index Data 3 ( RAPID 3), and the Disease Activity Score in 28 joints ( DAS 28)– ESR . Results Of 8298 patients, 56.2% met the proposed Boolean low disease activity criteria. We determined an SDAI score of 5.5 or less and a CDAI score of 5 or less to be the new cutoffs, and we chose a DAS 28 of 2.85 or less (the original cutoff for DAS ‐based minimal disease activity) and a RAPID 3 score of 6 or less (the original cutoff for RAPID3‐based low disease activity) with or without a swollen joint count ( SJC ) ( SJC of 2 or fewer) as the cutoffs for DAS 28 and RAPID 3. The agreement between the new cutoffs for DAS 28 of 2.85 or less vs. CDAI score of 5 or less, CDAI score of 5 or less vs. RAPID 3 score of 6 or less (with SJC of 2 or fewer), and DAS 28 of 2.85 or less vs. RAPID 3 score of 6 or less (with SJC of 2 or fewer), was 0.619, 0.612 (0.702), and 0.474 (0.531), respectively. Conclusion OMERACT 's minimal disease activity definition may be used to standardize the criteria for low disease activity.