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Letter
CDAI and DAS28 in the management of rheumatoid arthritis in clinical practice
  1. Satoshi Takanashi,
  2. Yuko Kaneko,
  3. Tsutomu Takeuchi
  1. Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
  1. Correspondence to Professor Tsutomu Takeuchi; tsutake{at}z5.keio.jp

http://dx.doi.org/10.1136/annrheumdis-2019-216607

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    The primary therapeutic target for rheumatoid arthritis is remission, assessed using validated composited measures.1 Currently, index-based remission frequently used in clinical practice are disease activity (CDAI) and Disease Activity Score for 28 joints (DAS28). Generally, it has been reported that CDAI is more stringent than DAS28 in assessing clinical remission.1 2 However, this confirmation was mainly derived from trial results. Hence, this study aimed to investigate the real-world performance of CDAI and DAS28-erythrocyte sedimentation rate (ESR).

    In total, 1585 consecutive patients with rheumatoid arthritis (mean age: 64 years, sex: 84% were women, mean disease duration: 12.0 years) in Keio University Hospital were reviewed cross-sectionally. Current treatments were conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) alone, tumour necrosis factor inhibitors (TNFi), interleukin 6 receptor inhibitors (IL-6i), cytotoxic T-lymphocyte associated antigen (CTLA)-4Ig and janus kinase inhibitors (JAKi) in 39.2%, 29.0%, 22.8%, 7.1% and 1.8% patients, respectively. Definition of cut-offs of each composite scores was following; remission, CDAI ≤2.8, DAS28-ESR <2.6; low disease activity, CDAI ≤10, DAS28-ESR <3.2; moderate disease activity; CDAI ≤22, DAS28-ESR≤5.1; high disease activity, CDAI >22, DAS28-ESR >5.1.

    First, we focused on the patients in CDAI remission (62.7% in all, 66.4% treated with csDMARDs, 65.8% treated with TNFi, 58.6% treated with IL-6i, …

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    Footnotes

    • Handling editor Gerd R Burmester

    • Contributors ST, YK and TT designed the study. ST wrote first draft of the manuscript. All authors edited the manuscript and approved the final version.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests YK has received grants or speaking fees from AbbVie, Astellas, Ayumi, Bristol-Myers Squibb, Chugai, Eisai, Eli Lilly, Hisamitsu, Jansen, Kissei, Pfizer, Sanofi, Takeda, Tanabe-Mitsubishi and UCB. TT has received research grants or speaking fees from Astellas Pharma, Bristol–Myers K.K., Chugai Pharmaceutical, Daiichi Sankyo, Takeda Pharmaceutical, Teijin Pharma, AbbVie GK, Asahikasei Pharma Corp., Mitsubishi Tanabe Pharma, Astra Zeneca K.K., Eli Lilly Japan K.K., Novartis Pharma K.K., Abbivie GK, Nipponkayaku, Janssen, Pharmaceutical K.K., Taiho Pharmaceutical and Pfizer Japan.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.