Objectives To identify effective predictors of remission in patients with rheumatoid arthritis (RA).
Methods Total Joint indices (TJI) of upper/large, upper/small, lower/large, and lower/small regions were calculated as the sum of tender and swollen joint counts divided by the number of evaluable joints in each region of interest (1). Data of 369 RA patients receiving MTX from Kurashiki Medical Center were applied to obtain logistic models for predicting the probability of remission. These models were validated using data of 6202 patients from NinJa 2010, an annually updated nationwide database in Japan.
Results TJI of all the regions were effective predictors for new ACR/EULAR (A/E), SDAI, CDAI, boolean and DAS28 remission definitions (table 1). Larger odds ratio (OR) means higher probability of remission. Upper joints, especially in upper/small were more effective predictors for A/E and SDAI remission than lower joints. OR for each region, except for upper/small region in DAS28 remission was similar to that in A/E and SDAI remission. OR for every joint region in CDAI remission was relatively high and upper/larger region was the highest of all. OR for upper/large region in boolean remission was relatively low compared to other remission definitions. Overall percentage of correct classification of NinJa data were 83.9% for A/E, 85.3% for SDAI, 85.7% for CDAI, 80.7% for boolean, and 78.0% for DAS28 remission. Data satisfied A/E were classified into 2 groups: physician global assessment ≤1cm and >1cm. The rates of positive TJI in upper/large and lower/large regions were 18.5 and 19.7% for >1cm group, respectively, and were significantly higher than those for ≤1cm group (10.9 and 9.5%, respectively).
Conclusions Upper/small joints were emphasized in A/E and SDAI remission compared to DAS28 remission. Physicians had respect for affected large joints in patients with A/E remission.
Nishiyama S, et al, Proposing a method of regional assessment and a novel outcome measure in rheumatoid arthritis. Rheumatol Int. DOI 10.1007/s00296-011-2058-9, 2011
Disclosure of Interest None Declared
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