Soubrier Martin, Zerkak Djamila, Gossec Laure, Ayral Xavier, Roux Christian, Dougados Maxime
Service de Rhumatologie, Hôpital G. Montpied, Clermont-Ferrand, France.
J Rheumatol. 2006 Jul;33(7):1243-6. Epub 2006 Apr 15.
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.
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.
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).
In our study, swollen joint count was the variable with the greatest weight, which explains the observed better performance of SDAI.
在临床实践中确定类风湿关节炎（RA）的哪些临床状态变量与改善病情抗风湿药（DMARD）治疗的变化最密切相关。
对204例连续的RA患者进行了一项前瞻性单中心研究。风湿病学家记录了患者的特征、治疗情况和疾病活动数据[压痛和肿胀关节计数（28个）、晨僵、疼痛视觉模拟量表（VAS，0 - 100毫米）、患者整体评估和医生整体评估、魏氏血沉率（ESR）和C反应蛋白（CRP）]。风湿病学家决定是否开始或改变治疗，但未被告知他们的决定是研究的一部分。进行逻辑回归分析以评估哪些研究变量最能预测治疗变化。采用ROC分析来获得不同综合指数[DAS28（ESR）、DAS28（CRP）、SDAI]用于治疗变化的截断值，以及敏感性和特异性。
对治疗变化具有预测性的变量（按降序排列）为：肿胀关节计数、晨僵、CRP、压痛关节计数和患者整体评估。与决定改变DMARD治疗相关的综合指数值为：DAS28（ESR）4.2（敏感性87%，特异性70%）；DAS28（CRP）3.6（敏感性86%，特异性78%）；SDAI 15（敏感性90%，特异性86%）。SDAI的判别能力优于DAS28（CRP）或DAS28（ESR）。
在我们的研究中，肿胀关节计数是权重最大的变量，这解释了观察到的SDAI更好的性能。
