Objectives To evaluate the impact of morning stiffness duration reported by the patient on the evaluation of rheumatoid arthritis activity.
Methods A multi- national cross-sectional study that included 1129 patients with rheumatoid arthritis according to the 1987 ACR criteria. The Quest-RA (Quantitative Standard monitoring of patients with Rheumatoid Arthritis)” Morocco study was inspired from the Finnish study, including public and private rheumatologists over a period from January 2008 to December 2010. A pre- questionnaire with Socio- demographic, clinical and paraclinical was completed by all patients. The duration of the Morning Stiffness (MS) was evaluated from the time of awakening patients until the maximum improvement in pain. Four groups were established according to the disease activity (DAS28 values in and MS). We conducted correlation analysis to establish the relationship between MS and disease activity based on DAS28. Linear regression analysis was used to identify the determinants of this relationship. The ROC curve was used to differentiate between active and inactive forms in the MS and the DAS28.
Results The average age of our patients was 48.82±12.72 years with a female predominance (87.3%). The median disease duration was 6 years (3-12). The mean DAS28 was 4.93±1.68, the length of the MS averaged 29.95±19.16 min. A significant correlation was noted between the DAS28 (r =0.318) VAS tired (r =0.343) overall VAS (r =0.315) ESR (r =0.144) and the duration of the MS (all p<0.05). More than half of our patients were severe activity DAS28 (54%). Among this group, 71.5% had a sup MS 30 minutes (16 - 59min). The duration of MS in patients with severe activity was different from subjects in the other groups (p<0.0001). In univariate and multivariate analysis and adjusting for confounding factors, the DAS28 increased 8.6 10-2 when the duration of the MS increases a minute. The Roc curve is a threshold value of 16.50 with Specificity =0.57 and Sensibility =0.77.
Conclusions Our study suggests that the MS reported by patients influences the disease activity assessed by the DAS28.
Disclosure of Interest None declared
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