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Development of the ClinESSDAI: a clinical score without biological domain. A tool for biological studies
  1. Raphaèle Seror1,
  2. Petra Meiners2,
  3. Gabriel Baron3,
  4. Hendrika Bootsma4,
  5. Simon J Bowman5,
  6. Claudio Vitali6,
  7. Jacques-Eric Gottenberg7,
  8. Elke Theander8,
  9. Athanasios Tzioufas9,
  10. Salvatore De Vita10,
  11. Manel Ramos-Casals11,
  12. Thomas Dörner12,
  13. Luca Quartuccio10,
  14. Philippe Ravaud3,
  15. Xavier Mariette1
  16. on behalf of the EULAR Sjögren Task Force
  1. Elena Bartoloni,
  2. Roberto Gerli,
  3. Stefano Bombardieri,
  4. Cees Kallenberg,
  5. Simon J Bowman,
  6. Johan G Brun,
  7. Roberto Caporali,
  8. Valerie Devauchelle,
  9. Alain Saraux,
  10. Anne-Laure Fauchais,
  11. Jacques Eric Gottenberg,
  12. Eric Hachulla,
  13. Aike A Kruize,
  14. Thomas Mandl,
  15. Elke Theander,
  16. Xavier Mariette,
  17. Frederic Demoulins,
  18. Le Kremlin Bicêtre,
  19. Carlomaurizio Montecucco,
  20. Wan-Fai Ng,
  21. Sonja Praprotnik,
  22. Matija Tomsic,
  23. Manel Ramos Casals,
  24. Hal Scofield,
  25. Kathy L. Sivils,
  26. Roser Solans Laqué,
  27. Takayuki Sumida,
  28. Sumusu Nishiyama,
  29. Guido Valesini,
  30. Valeria Valim,
  31. Cristina Vollenweider
  1. 1Assistance Publique-Hôpitaux de Paris, Université Paris-Sud, (AP-HP), Service de Rhumatologie, Hôpitaux Universitaires Paris-Sud, Center of Research on Immunology of Viral and Autoimmune diseases (IMVA), Le Kremlin Bicêtre, France
  2. 2Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  3. 3Faculty of Medicine, AP-HP, Hôtel Dieu Hospital, Centre of Clinical Epidemiology, University of Paris Descartes,Paris, France
  4. 4Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  5. 5Rheumatology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  6. 6Sections of Rheumatology, Instituto San Giuseppe, Como and Casa di Cura di Lecco, Lecco, Italy
  7. 7Department of Rheumatology, Centre National de Référence des Maladies Auto-Immunes Rares, INSERM UMRS_1109, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg university Hospital, Université de Strasbourg, Strasbourg, France
  8. 8Department of Rheumatology, Skane University Hospital Malmö, Lund University, Malmö, Sweden
  9. 9Department of Pathophysiology, School of Medicine, University of Athens, Athens, Greece
  10. 10Department of Medical and Biological Sciences, Clinic of Rheumatology, Udine University, Udine, Italy
  11. 11Laboratory of Autoimmune Diseases ‘Josep Font’, CELLEX-IDIBAPS, Department of Autoimmune Diseases, ICMiD, Hospital Clinic, Barcelona, Spain
  12. 12Rheumatology Department, Charité, University Hospital, Berlin, Germany
  1. Correspondence to Dr Raphaèle SEROR, Department of Rheumatology, Hôpital Bicêtre, 78 rue du Général Leclerc, Le Kremlin Bicêtre 94275, France;{at}


Objective To develop and validate ClinESSDAI (Clinical European League Against Rheumatism Sjögren's Syndrome Disease Activity Index), ie, ESSDAI without the biological domain.

Patients and methods The 702 fictive vignettes derived from 96 real cases of primary Sjögren's syndrome of the ESSDAI development study were used. As for ESSDAI development, the physician assessment of disease activity (0–10 scale) was used as the ‘gold standard’ in a multivariate model for weighting domains, after removing the biological domain. The reliability, assessed by intraclass correlation coefficient (ICC) between ClinESSDAI and ESSDAI, explored if ClinESSDAI was equivalent to ESSDAI. Its psychometric (ie, measurement) properties were compared with that of ESSDAI in an independent cohort. Also, its use was evaluated on data of two clinical trials.

Results In multivariate modelling, all 11 domains remained significantly associated with disease activity, with slight modifications of some domain weights. Reliability between clinESSDAI and ESSDAI was excellent (ICC=0.98 and 0.99). Psychometric properties of clinESSDAI, disease activity levels and minimal clinically important improvement thresholds and its ability to detect change over time in clinical trials were very close to that of ESSDAI.

Conclusions ClinESSDAI appears valid and very close to the original ESSDAI. This score provides an accurate evaluation of disease activity independent of B-cell biomarkers. It could be used in various circumstances: (i) in biological/clinical studies to avoid data collinearity, (ii) in clinical trials, as secondary endpoint, to detect change independent of biological effect of the drug, (iii) in clinical practice to assess disease activity for visits where immunological tests have not been done.

  • Disease Activity
  • Sjøgren's Syndrome
  • Outcomes research

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