Document Detail

Reevaluation of the role of duration of morning stiffness in the assessment of rheumatoid arthritis activity.
MedLine Citation:
PMID:  19833759     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To evaluate the utility of the duration of morning stiffness (MS), as a patient-reported outcome (PRO), in assessing rheumatoid arthritis (RA) disease activity. METHODS: We acquired information on 5439 patients in QUEST-RA, an international database of patients with RA evaluated by a standard protocol. MS duration was assessed from time of waking to time of maximal improvement. Ability of MS duration to differentiate RA activity states, based on Disease Activity Score (DAS)28, was assessed by analysis of variance; and a receiver-operating characteristic (ROC) curve was plotted for discriminating clinically active (DAS28 > 3.2) from less active (DAS28 <or= 3.2) RA. Mixed-effect analysis of covariance (ANCOVA) models were used to assess the utility of adding MS duration to Routine Assessment of Patient Index Data (RAPID)3, a PRO index based on physical function, pain, and general health (GH), in predicting the 3-variable DAS28 (DAS28v3). RESULTS: MS duration had moderate correlation (r = 0.41-0.48) with pain, Health Assessment Questionnaire, and GH; and weak correlation (r = 0.23-0.39) with joint counts and erythrocyte sedimentation rate. MS duration differed significantly among patients with different RA activity (p < 0.001). The area under the ROC curve of 0.74 (95% CI 0.72-0.75) showed moderate ability of MS duration to differentiate clinically active from less active RA. ANCOVA showed significant interactive effects between RAPID3 and the MS duration categories (p = 0.0005) in predicting DAS28v3. The effect of MS was found to be clinically important in patients with the low RAPID3 scores (< 6) in whom the presence of MS may indicate clinically active disease (DAS28v3 > 3.2). CONCLUSION: MS duration has a moderate correlation with RA disease activity. Assessment of MS duration may be clinically helpful in patients with low RAPID3 scores.
Nasim A Khan; Yusuf Yazici; Jaime Calvo-Alen; Jolanta Dadoniene; Laure Gossec; Troels M Hansen; Margriet Huisman; Riina Kallikorm; Raili Muller; Margareth Liveborn; Rolf Oding; Elena Luchikhina; Antonio Naranjo; Sylejman Rexhepi; Peter Taylor; Witold Tlustochowich; Afrodite Tsirogianni; Tuulikki Sokka;
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Publication Detail:
Type:  Journal Article     Date:  2009-10-15
Journal Detail:
Title:  The Journal of rheumatology     Volume:  36     ISSN:  0315-162X     ISO Abbreviation:  J. Rheumatol.     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-11-06     Completed Date:  2010-02-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7501984     Medline TA:  J Rheumatol     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  2435-42     Citation Subset:  IM    
University of Arkansas for Medical Sciences,Central Arkansas Veterans Healthcare System, Little Rock, Arkansas 72205, USA.
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MeSH Terms
Arthritis, Rheumatoid* / pathology,  physiopathology
Databases, Factual*
Joints* / pathology,  physiopathology
Middle Aged
ROC Curve
Severity of Illness Index*

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