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Comparison of composite measures of disease activity in an early seropositive rheumatoid arthritis cohort
  1. Veena K Ranganath1,*,
  2. Jeonglim Yoon1,*,
  3. Dinesh Khanna2,
  4. Grace S Park1,
  5. Daniel E Furst1,
  6. David A Elashoff1,
  7. Damini Jawaheer1,
  8. John T Sharp3,
  9. Richard H Gold1,
  10. Edward C Keystone4,
  11. Harold E Paulus1
  1. 1
    University of California, Los Angeles, California, USA
  2. 2
    Division of Immunology, Department of Internal Medicine, Institute for Study of Health, University of Cincinnati, Cincinnati, Ohio, USA and Veterans Affairs Medical Center, Cincinnati, Ohio, USA
  3. 3
    University of Washington, Seattle, Washington, USA
  4. 4
    University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada
  1. Dr H E Paulus, UCLA, Department of Medicine, Division of Rheumatology, Rehabilitation Center, Room 32-59, 1000 Veteran Avenue, Los Angeles, CA 90095-1670, USA; hpaulus{at}


Objective: To evaluate concordance and agreement of the original DAS44/ESR-4 item composite disease activity status measure with nine simpler derivatives when classifying patient responses by European League of Associations for Rheumatology (EULAR) criteria, using an early rheumatoid factor positive (RF+) rheumatoid arthritis (RA) patient cohort.

Methods: Disease-modifying anti-rheumatic drug-naïve RF+ patients (n = 223; mean duration of symptoms, 6 months) were categorised as ACR none/20/50/70 responders. One-way analysis of variance and two-sample t tests were used to investigate the relationship between the ACR response groups and each composite measure. EULAR reached/change cut-point scores were calculated for each composite measure. EULAR (good/moderate/none) responses for each composite measure and the degree of agreement with the DAS44/ESR-4 item were calculated for 203 patients.

Results: Patients were mostly female (78%) with moderate to high disease activity. A centile-based nomogram compared equivalent composite measure scores. Changes from baseline in the composite measures in patients with ACRnone were significantly less than those of ACR20/50/70 responders, and those for ACR50 were significantly different from those for ACR70. EULAR reached/change cut-point scores for our cohort were similar to published cut-points. When compared with the DAS44/ESR-4 item, EULAR (good/moderate/none) percentage agreements were 92 with the DAS44/ESR-3 item, 74 with the Clinical Disease Activity Index, and 80 with the DAS28/ESR-4 item, the DAS28/CRP-4 item and the Simplified Disease Activity Index.

Conclusion: The relationships of nine different RA composite measures against the DAS44/ESR-4 item when applied to a cohort of seropositive patients with early RA are described. Each of these simplified status and response measures could be useful in assessing patients with RA, but the specific measure selected should be pre-specified and described for each study.

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  • These authors contributed equally to this work.

    The Western Consortium of Practicing Rheumatologists: Robert Shapiro, Maria W Greenwald, H Walter Emori, Fredrica E Smith, Craig W Wiesenhutter, Charles Boniske, Max Lundberg, Anne MacGuire, Jeffry Carlin, Robert Ettlinger, Michael H Weisman, Elizabeth Tindall, Karen Kolba, George Krick, Melvin Britton, Rudy Greene, Ghislaine Bernard Medina, Raymond T Mirise, Daniel E Furst, Kenneth B Wiesner, Robert F Willkens, Kenneth Wilske, Karen Basin, Robert Gerber, Gerald Schoepflin, Marcia J Sparling, George Young, Philip J Mease, Ina Oppliger, Douglas Roberts, J Javier Orozco Alcala, John Seaman, Martin Berry, Ken J Bulpitt, Grant Cannon, Gregory Gardner, Allen Sawitzke, Andrew Lun Wong, Daniel O Clegg, Timothy Spiegel, Wayne Jack Wallis, Mark Wener, Robert Fox

  • Funding: The study was supported by Specialty Laboratories (Valencia, CA, USA), with previous support from NIH Multipurpose Arthritis and Musculoskeletal Disease Center Grant P60 AR 36834. VR was supported in part by ASP/REF/ACR Junior Career Development Award in Geriatrics and the OAIC Career Development Award. DK’s work was supported in part by the Arthritis and Scleroderma Foundations (Physician Scientist Development Award), and a National Institutes of Health BIRCWH award (grant No HD051953).

  • Competing interests: None.

  • Abbreviations:
    American College of Rheumatology
    Clinical Disease Activity Index
    C-reactive protein
    Disease Activity Score
    disease-modifying anti-rheumatic drug
    erythrocyte sedimentation rate
    European League of Associations for Rheumatology
    rheumatoid arthritis
    Simplified Disease Activity Index

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