Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA.
J Rheumatol. 2010 Aug 1;37(8):1607-14. doi: 10.3899/jrheum.090831. Epub 2010 Jul 1.
To develop and validate a modified version of the Disease Activity Score with 28 joint count (mDAS28), for use in epidemiological research, when acute-phase reactant values are unavailable.
In a cross-sectional development cohort (5729 patients), statistically significant predictors of the logarithm of erythrocyte sedimentation rate (lnESR) were identified. After computation of the mDAS28, a cross-sectional validation cohort (5578 patients) was used to evaluate internal, criterion, and construct validities. The ability of the mDAS28 to discriminate between disease states was also assessed. A second validation cohort (longitudinal, 336 pairs of patient visits) was used to assess sensitivity to change.
Significant predictors of lnESR included tender and swollen joints with 28 counts, patient's and physician's assessments of global health, and patient's assessment of pain (visual analog scale 0-100 mm) and a physical function (modified Health Assessment Questionnaire 0-3; mHAQ). Satisfactory internal validity (alpha = 0.72) and strong criterion validity compared to the DAS28, the Simplified Disease Activity Index (SDAI), and the Clinical Disease Activity Index (CDAI) (r = 0.87-0.96) were found. Predictive validity was demonstrated by good correlation with the mHAQ (r = 0.58). The mDAS28 showed substantial agreement with the DAS28, SDAI, and CDAI in discriminating between disease states (kappa = 0.70-0.77) and moderate to substantial agreement between response levels (kappa = 0.52-0.73). Both mDAS28 and DAS28 measures classified patients similarly in remission compared to the SDAI and CDAI. The mDAS28 was superior in detecting change (standardized response mean = 0.58) followed by the DAS28, CDAI, and SDAI.
The mDAS28 is a valid and sensitive tool to assess disease activity in epidemiological research, as an alternative to the DAS28, when acute-phase reactant values are unavailable.
开发并验证一种简化的 28 关节疾病活动评分（mDAS28），用于在缺乏急性时相反应物值的情况下进行流行病学研究。
在一项横断面研究队列（5729 例患者）中，确定了红细胞沉降率（ESR）对数的统计学显著预测因子。计算 mDAS28 后，使用横断面验证队列（5578 例患者）评估内部、标准和结构有效性。还评估了 mDAS28 区分疾病状态的能力。第二个验证队列（纵向，336 对患者就诊）用于评估对变化的敏感性。
ESR 的显著预测因子包括 28 个关节的压痛和肿胀关节、患者和医生的整体健康评估以及患者的疼痛（视觉模拟评分 0-100mm）和身体功能（改良健康评估问卷 0-3；mHAQ）。发现内部有效性（alpha = 0.72）和与 DAS28、简化疾病活动指数（SDAI）和临床疾病活动指数（CDAI）的强标准相关性（r = 0.87-0.96）令人满意。通过与 mHAQ 的良好相关性（r = 0.58）证明了预测有效性。mDAS28 在区分疾病状态方面与 DAS28、SDAI 和 CDAI 具有显著相关性（kappa = 0.70-0.77），在反应水平之间具有中度至显著相关性（kappa = 0.52-0.73）。与 SDAI 和 CDAI 相比，mDAS28 和 DAS28 测量均能将患者分类为缓解状态。在检测变化方面，mDAS28 优于 DAS28、CDAI 和 SDAI（标准化反应均值 = 0.58）。
当缺乏急性时相反应物值时，mDAS28 是一种替代 DAS28 的有效且敏感的工具，可用于评估流行病学研究中的疾病活动。
