Search J Rheum

Advanced Search

Home

Current Issue

Archives

Guidelines for Authors

Classified Ads

Links

Search PubMed

Subscriptions

Subscriber Registration

Guidelines for Website Users

JRheum Update Service

Contact Info


Download PDF


View Table of Contents

Which Variables Best Predict Change in Rheumatoid Arthritis Therapy in Daily Clinical Practice?

MARTIN SOUBRIER, DJAMILA ZERKAK, LAURE GOSSEC, XAVIER AYRAL, CHRISTIAN ROUX, and MAXIME DOUGADOS

ABSTRACT.

Objective. To determine in clinical practice which clinical status variables for rheumatoid arthritis (RA) are most closely associated with a change in disease modifying antirheumatic drug (DMARD) therapy.

Methods. A prospective monocenter study was conducted in 204 consecutive patients with RA. Rheumatologists recorded patient characteristics, treatments, and disease activity data [tender and swollen joint count (28), morning stiffness, visual analog scale (VAS) for pain (0–100 mm), patient global assessment and physician global assessment, Westergren erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP)]. The rheumatologists decided whether or not to initiate or change treatment but were not informed that their decisions were part of the investigation. Logistic regression analysis was performed to evaluate which study variables best predict change in therapy. ROC analysis was used to obtain the cutoff value of the different composite indices (DAS28(ESR), DAS28(CRP), SDAI) for treatment change, as well as sensitivity and specificity.

Results. The variables that were predictive for a change in treatment were (in descending order): swollen joint count, morning stiffness, CRP, tender joint count, and patient global assessment. Composite index values associated with a decision to modify DMARD therapy were: DAS28(ESR) 4.2 (sensitivity 87%, specificity 70%); DAS28(CRP) 3.6 (sensitivity 86%, specificity 78%); and SDAI 15 (sensitivity 90%, specificity 86%). The discriminative ability of SDAI was better than that of DAS28(CRP) or DAS28(ESR).

Conclusion. In our study, swollen joint count was the variable with the greatest weight, which explains the observed better performance of SDAI. (First Release April 15 2006; J Rheumatol 2006;33:1243–6)

Key Indexing Terms:

RHEUMATOID ARTHRITIS
DISEASE ACTIVITY
DISEASE ACTIVITY SCORE 28
SIMPLIFIED DISEASE ACTIVITY INDEX

 


From the Service de Rhumatologie, Hôpital G. Montpied, Clermont-Ferrand; and Service de Rhumatologie, Université René Descartes, AP-HP Hôpital Cochin, Paris, France.

M. Soubrier, MD, PhD, Service de Rhumatologie, Hôpital G. Montpied; D. Zerkak, MD; L. Gossec, MD; X. Ayral, MD; C. Roux, MD, PhD; M. Dougados, MD, Service de Rhumatologie, Université René Descartes, AP-HP Hôpital Cochin.

Address reprint requests to Dr. M. Soubrier, Service de Rhumatologie, Hôpital G. Montpied, Place H. Dunant, BP 69, 63003 Clermont-Ferrand, France. E-mail: msoubrier@chu-clermontferrand.fr

Accepted for publication February 10, 2006.

 




Return to July 2006 Table of Contents



© 2006. The Journal of Rheumatology Publishing Company Limited.
All rights reserved.