Background MCTD is a rare chronic inflammatory disorder characterized by periods of remissions and relapses, leading throughout the years to a damage of involved organs.
Objectives To evaluate activity and damage in MCTD and their clinical correlation.
Methods Since guidelines to evaluate the clinical state of patients with MCTD have not been yet established a set of subjective methods to assess disease activity and damage had to be devised specifically for the purpose of the study. Patients and physicians utilized a 100 mm visual analog scale (VAS) to mark a point along the scale corresponding to their assessment of the disease activity (VASptA, VASdrA) and disease-related damage (VASptD, VASdrD). Patients' functional ability was assessed using Health Assessment Questionnaire – Disability Index (HAQ-DI) while fatigue level – by Krupp's Fatigue Severity Scale (KFSS). Relationship between variables were analyzed by Spearman's rank correlation.
Results The studied population included 104 patients with MCTD (female 83%). Medians of patient's age was 43,5 ys and disease duration - 109,5 mo. Medians of VASptA was 38,4 mm and VASdrA – 20,7 mm. In 4 cases patient's and physician's assessment of disease activity was in full agreement. In 82 cases VASptA was higher, in 18 cases – lower than VASdrA. Patient's versus physician's assessement of disease activity correlated moderately (R=0,44, p<0,001). There was a strong correlation between VASptA and HAQ-DI (R=0,53, p<0001) and moderate/ strong correlation between VASptA and fatigue (R=0,49, p<0,0001). VASdrA correlated with the type of therapeutic program: the highest values on the VAS scale were observed in a group intensively treated patients, while the lowest – in the remission group (VASdrA 30,5 mm v 17,4 mm)1. Median of VASptD was 39,1 mm and VASdrD – 28,1 mm. In 6 cases, assessment of damage by patient was in accordance with physician's opinion, in 70 cases VASptD was higher, in 28 cases – lower than VASdrD. There was high correlation between VASptD and HAQ-DI (R=0,59, p<0,0001) and moderate between VASptD and fatigue (R=0,47, p<0,0001). VASdrD correlated moderately with HAQ-DI (R=0,35, p=0,0003) and disease duration (R=0,36, p=0,0002). Patient's versus physician's assessement of disease damage correlated strongly (R=0,52, p<0,0001)2.
Conclusions Our data provide new and important information on subjective vs. objective assessment of the MCTD activity and damage. Patients'assessement was more severe and correlated with functional disability and fatigue while doctors' assessment was in accordance with objective measurements like disease duration and intensity of treatment.
Leong KP, Chong EY, Kong KO, et al. Discordant assessment of lupus activity between patients and… Lupus 2010;19:100-106.
Neville C, Clarke AE, Joseph L, et al. Learning from discordance… J Rheumatol 2000;27:675-679.
Disclosure of Interest None declared