Background In addition to familiar DAS28, SDAI and CDAI have been routinely used in the clinical studies or in clinical setting. New remission criteria have been also developed. These new movement in the treatment of rheumatoid arthritis (RA) cause a little chaos in real-world clinical setting. What should we physicians use in the evaluation of a patient in front of us?
Objectives The aim of this study is to compare four composite measures (DAS28-ESR, DAS28-CRP, SDAI, CDAI) and new remission criteria (Boolean) in patients with RA treated with anti-TNF agents and to determine the characteristics of each measure. Two sets of cut-off point were used in case of DAS28-CRP. One is original cut-off points (5.1, 3.2, 2.6) and the other is developed by Tokyo women’s university (4.1, 2.7, 2.3) in Japan. The latter is called DAS28-CRP (IORRA).
Methods 153 RA patients treated with anti-TNF agents (130 female and 23 male) were included in this retrospective study. Disease activity was evaluated using four composite measures at the time of starting anti-TNF agents and at the time of last observation and compared with each other. The rate of remission was also evaluated at the time of last observation.
Results The rates of high disease activity (HDA) were 85.6% using DAS28-CRP (IORRA), 75.2% using DAS28-ESR, 62.5% using SDAI, 61.8% using CDAI and 56.2% using DAS28-CRP at the time of starting anti-TNF therapy in all cases (n=153). There were significant differences in the rate of HDA among every couple except for SDAI, CDAI and DAS28. The rates of low disease activity (LDA) were 77.5% using SDAI, 76.6% using SDAI, 73.8% using CDAI, 60.3% using DAS28-CRP (IORRA) and 45.0% using DAS28-ESR at the time of last visit in only cases who continued anti-TNF therapy (n=111). There were significant differences in the rate of LDA among every couple except for SDAI, CDAI and DAS28. The rates of remission were 19.8% using Boolean-4, 21.6% using Boolean-3, 24.3% using CDAI, 25.2% using SDAI, 34.2% using DAS28-ESR, 46.8% using DAS28-CRP (IORRA) and 59.5% using DAS28-CRP at the time of last visit in only cases continuing anti-TNF therapy (n=111). Patients who achieved Boolean-4 remission (n=22) were significantly young, had significantly short RA duration and used significantly fewer prednisolone and more MTX compared with patients who did not achieved Boolean-4 remission (n=89).
Conclusions Although SDAI and CDAI were stringent among the definitions of remission, they were also lenient among the definitions of LDA. Although LDA is alternative goal in T2T strategy, it is unclear which measure should be used in case of LDA. DAS28-ESR was most stringent among the definitions of LDA. Boolean-4 was most stringent among the criteria of remission. This study suggested that early intervention with MTX and biologics was one of the methods ahead to remission defined by Boolean-4.
Disclosure of Interest None Declared
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.