Background 2011 the ACR and EULAR proposed new remission criteria for Rheumatoid arthritis (RA) . According to this publication from now on wording of the question about patient’s global assessment should be as follows: “Considering all of the ways your arthritis has affected you, how do you feel your arthritis is today?” In the past general health was not explicitly connected to arthritis but to the general health condition.
Objectives It was of interest if the use of the new wording influences the agreement of composite scores to patient centred disease activity assessment tools like for example the Rheumatoid Arthritis Disease Activity Index comprising 5 questions (RADAI-5) which has shown significant correlation to the commonly used composite indices [2,3].
Methods 177 consecutive outclinic RA patients (74% female, mean age 63,6 years, 55.9% RF pos, mean disease duration 110 months) were asked to answer both questions (“How is your general health today?” and “Considering all of the ways your arthritis has affected you, how do you feel your arthritis is today?”) on a 100 mm visual analogue scale (VAS-old and VAS-new). Moreover DAS28, SDAI and CDAI were calculated twice using both questions. Furthermore patients were asked to complete the RADAI-5 to correlate this questionnaire to the other composite scores. Cohen’s kappa was calculated to show the agreement of both results.
Results The mean RADAI-5 was 3.17 (95%CI 2.85 - 3.49). Agreement of VAS-old and VAS-new was moderate (kappa =0.41). The RADAI-5 agrees better to SDAI and CDAI using VAS-new than VAS-old (kappa =0.68 vs. 0.27 and 0.76 vs. 0.27 respectively). No substantial difference was found for the agreement between RADAI-5 and DAS28 using both wordings (kappa =0.20 vs. 0.26).
Conclusions VAS-old and VAS-new showed a moderate agreement. No difference in agreement of the DAS28 and the RADAI-5 was seen using both wordings. By introducing the new wording the SDAI and the CDAI become much more congruent with the RADAI-5 and probably other patient related outcomes.
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Bossert M, Prati C, Vidal C et al. Joint Bone Spine. 2012 Jan;79(1):57-62.
Disclosure of Interest None Declared
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