Document Detail

Evaluation of composite measures of treatment response without acute-phase reactants in patients with rheumatoid arthritis.
MedLine Citation:
PMID:  19395544     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: To evaluate composite measures of response without acute-phase reactants in RA patients. Specifically, Clinical Disease Activity Index (CDAI)-derived response criteria were compared with the European League Against Rheumatism (EULAR) response criteria, and the modified ACR (mACR) response criteria were compared to the ACR response criteria.
METHODS: Data from 10 108 RA patients enrolled in the Consortium of Rheumatology Researchers of North America registry were examined, including 649 patients initiating DMARD therapy. CDAI cut-off points for disease activity levels and responses were derived using receiver operating characteristic curves with the DAS28 and EULAR response criteria as gold standards. The kappa-statistics were applied to assess agreement between CDAI-derived and EULAR-defined responses, as well as ACR20 and ACR50 with mACR20- and mACR50-defined responses, respectively.
RESULTS: For the components of the EULAR response, the derived CDAI cut-off points for DAS28 levels of 3.2 and 5.1 were 7.6 and 19.6, respectively. The derived CDAI cut-off points were 4.3 and 10.0 for DAS28 changes of 0.6 and 1.2, respectively. There were moderate to substantial agreements between CDAI-derived and EULAR responses (kappa = 0.57-0.71). Agreement of ACR20 and ACR50 with mACR20 and mACR50 responses, respectively, was excellent (kappa = 0.88-0.95).
CONCLUSIONS: Agreement between composite measures of response without acute-phase reactants and standard measures ranged from moderate to excellent. The mACR20 and mACR50 criteria as well as CDAI-derived response criteria, can serve as composite measures of response in clinical practice and research settings without access to acute-phase reactants.
Jeffrey D Greenberg; Leslie R Harrold; Mary J Bentley; Joel Kremer; George Reed; Vibeke Strand
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article; Multicenter Study; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2009-04-24
Journal Detail:
Title:  Rheumatology (Oxford, England)     Volume:  48     ISSN:  1462-0332     ISO Abbreviation:  Rheumatology (Oxford)     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-05-14     Completed Date:  2009-07-06     Revised Date:  2014-09-08    
Medline Journal Info:
Nlm Unique ID:  100883501     Medline TA:  Rheumatology (Oxford)     Country:  England    
Other Details:
Languages:  eng     Pagination:  686-90     Citation Subset:  AIM; IM    
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MeSH Terms
Acute Disease
Antirheumatic Agents / therapeutic use*
Arthritis, Rheumatoid / drug therapy*,  immunology,  psychology
Middle Aged
ROC Curve
Severity of Illness Index*
Treatment Outcome
Grant Support
Reg. No./Substance:
0/Antirheumatic Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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