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[2011] [FRI0057] VALIDITY OF A
MODIFIED VERSION OF THE DAS28 USING ULTRASOUND POWER
DOPPLER
A.M. Bertoli, M. Audisio, G. Py, M. Baravalle, L. Morales, I.
Strusberg, A. Strusberg Instituto Reumatologico Strusberg, Córdoba,
Argentina
Background: Clinical instruments currently used to assess
disease activity in rheumatoid arthritis (RA) do not seem to be
specific enough to define the state of remission. The search of new
instruments to assess remission is actually part of the current
research agenda.
Objectives: To evaluate the performance of a modified
version of the DAS28 using ultrasound power Doppler (USPD), the
DAS-USPD herein, to assess disease activity and remission in
RA.
Methods:
We evaluated 82 RA patients fulfilling the 1987 ACR criteria. A
modified version of the DAS28, the DAS-USPD, was calculated by
replacing the swollen joint count by the USPD joint assessment of
inflammation in 28 joints. The performance of the DAS-USPD to
measure disease activity (construct validity) was calculated by its
comparison with the DAS28, the CDAI and the ACR criteria for
remission using the Spearman's rho test. The performance of the
DAS-USPD to measure remission (concurrent validity) was obtained by
classifying patient into remission versus active disease and
comparing this modified version with the DAS28 and CDAI using a
k test.
Results: Among the 82 patients, 66 (80,5%) were female, with
a mean age of 50,5 (SD 13,1) years and a median disease duration of
80,0 (25-75 percentile 45-127) months. The means value (SD) of the
DAS-USPD, DAS28 and CDAI were 3.41 (1.51), 3.43 (1.68) and 12.08
(13.67), respectively. Twenty-five (30.5%) patients were classified
into remission according to the DAS-USPD, 26 (31,7%) according to
the DAS28, 19 (23,2%) according to the CDAI and 22 (26.8%)
according to the ACR criteria for remission.
Table 1 depicts the construct and
concurrent validity of the DAS-USDP.
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Table 1. Construct and concurrent
validity of the DAS-USDP
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Validity of the DAS-PD
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DAS28
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CDAI
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ACR criteria for
remission
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Construct
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Convergent
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rho=0.97;
p<0.001
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rho=0.80;
p<0.001
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Divergent
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–0.75;
p<0.001
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Concurrent
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k=0.80;
p<0.001
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k=0.45;
p<0.001
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k=0.38; p=0.001
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Conclusions: Our results show a
good performance of the DAS-USPD to measure disease activity.
Nevertheless, its capacity to discriminate remission versus
activity its only moderate when compared with other clinical
instruments such as the CDAI and the ACR criteria for
remission.
References:
1.
Mierau M, Schoels M, Gonda G, Fuchs
J, Aletaha D, Smolen JS. Assessing remission in clinical practice.
Rheumatology (Oxford) 2007; 46(6):975-9.
2.
Aletaha D, Smolen JS. Remission of
rheumatoid arthritis: should we care about definitions? Clin Exp
Rheumatol 2006; 24(6 Suppl 43):S-51.
3.
Molenaar ET, Voskuyl AE, Dinant HJ,
Bezemer PD, Boers M, Dijkmans BA. Progression of radiologic damage
in patients with rheumatoid arthritis in clinical remission.
Arthritis Rheum 2004; 50(1):36-42.
4.
Aletaha D, Funovits J, Breedveld FC,
Sharp J, Segurado O, Smolen JS. Rheumatoid arthritis joint
progression in sustained remission is determined by disease
activity levels preceding the period of radiographic assessment.
Arthritis Rheum 2009; 60(5):1242-9.
Disclosure of
Interest: None Declared
Citation: Ann Rheum Dis 2011;70(Suppl3):364
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结合超声计数炎症关节的改良版DAS28的临床应用
Bertoli AM, et al. EULAR 2011.
Present No: FRI0057.
背景:
目前评估类风湿关节炎(RA)疾病活动度的临床工具在定义缓解状态时的特异性不够好。开发评估缓解的新工具已经成为当前研究课题之一了。
目的:
评估一种结合多普勒超声(PD)的改良版DAS28(即DAS-USPD)的性能，并探讨它在评估RA病情活动和缓解中应用。
方法:
我们评价了82例符合1987年ACR分类标准的RA病人。将DAS28中体检计数的肿胀关节数替换为USPD计数的炎症关节数(28个关节)，由此就有了一个改良版的DAS28。通过与DAS28、CDAI以及ACR的缓解定义相比较，用Spearman
rho检验分析DAS-USPD对疾病活动度的评估性能(建构效度)。通过将病人归类为缓解或疾病活动，并与DAS28、CDAI进行比较，用k检验来分析DAS-USPD对缓解的评估性能
(共时效度)。
结果:
在82例患者中，66例(5%)为女性，平均年龄为50.5岁(SD:
13.1)，病程中位数为80.0个月(25-75百分位数:
45-127)。DAS-USPD、DAS28以及CDAI的平均值(SD)分别为3.41
(1.51)，3.43
(1.68)和12.08
(13.67)。根据DAS-USPD判为缓解的病人有25例(30.5%)，获DAS28缓解的有26例(31.7%)，获CDAI缓解的有19例(23.2%)，达ACR缓解的有22例(26.8%)。
表1.
DAS-USDP的建构效度和共时效度。
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DAS-PD的效度
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DAS28
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CDAI
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ACR缓解标准
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建构效度
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收敛
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rho=0.97;
p<0.001
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rho=0.80;
p<0.001
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发散
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–0.75;
p<0.001
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共时效度
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k=0.80;
p<0.001
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k=0.45;
p<0.001
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k=0.38; p=0.001
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结论:
本研究显示DAS-USPD对RA疾病活动度有良好的判断性能。但是，与诸如CDAI和ACR的缓解标准等临床工具相比，它对疾病活动和缓解的鉴别能力仅能算作中等。
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