类风湿关节炎缓解：新提出的 ACR/EULAR 缓解标准与类风湿关节炎疾病活动指数-5（一种患者自我报告的疾病活动指数）的比较。

Remission in rheumatoid arthritis: a comparison of the 2 newly proposed ACR/EULAR remission criteria with the rheumatoid arthritis disease activity index-5, a patient self-report disease activity index.

机构信息

Lower Austrian State Hospital Stockerau, Second Department for Internal Medicine, Lower Austrian Centre for Rheumatology, Stockerau, Austria.

出版信息

J Rheumatol. 2013 Apr;40(4):394-400. doi: 10.3899/jrheum.120952. Epub 2013 Feb 1.

DOI:10.3899/jrheum.120952

PMID:23378466

Abstract

OBJECTIVE

We analyzed whether a patient self-report remission criterion, such as that according to the Rheumatoid Arthritis Disease Activity Index-5 (RADAI-5), meets the criteria of the 2011 proposed American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) definition of remission.

METHODS

The 2 approaches of the ACR/EULAR proposal [Boolean- and Simplified Disease Activity Index (SDAI)-based] as well as the RADAI-5 were used to assess whether patients with RA are in remission. Sensitivity, specificity, positive and negative predictive values (PPV, NPV), and kappa analyses were performed to illustrate the relationship among the different approaches defining remission at a group level.

RESULTS

In total, 705 patients' assessments were included. Eighty-nine patients were classified as being in remission according to the Boolean-based and 169 according to the SDAI-based definition of the ACR/EULAR proposals, and 154 according to the RADAI-5. Sixty-eight assessments were classified as being in remission according to all 3 definitions. In the case of RADAI-5 remission, sensitivity was 78%, specificity 86%, PPV 45%, and NPV 96%, indicating remission according to the Boolean-based definition; and 60%, 92%, 66%, and 90%, respectively, indicating remission according to the SDAI-based definition. In the case of remission according to the SDAI-based ACR/EULAR definition, sensitivity was 52%, specificity 100%, PPV 98%, and NPV 87%, also indicating remission according to the Boolean definition; while according to the Boolean definition the values were 98%, 87%, 52%, and 100%, respectively. Kappa statistics showed fair to good agreement for all 3 definitions.

CONCLUSION

Nearly twice as many assessments were classified as being in remission using the SDAI-based or the RADAI-5 definitions when compared to the Boolean-based definition. Remission according to the RADAI-5 also was highly specific for both ACR/EULAR criteria. Sensitivity for the RADAI-5 criterion was even better for the Boolean-based definition than that for the SDAI-based definition.

摘要

目的

我们分析了患者的自我报告缓解标准（例如，根据类风湿关节炎疾病活动指数-5 [RADAI-5]）是否符合 2011 年美国风湿病学会/欧洲抗风湿病联盟（ACR/EULAR）提出的缓解定义标准。

方法

使用 ACR/EULAR 建议的两种方法（基于布尔值和简化疾病活动指数[SDAI]）以及 RADAI-5 来评估患有 RA 的患者是否处于缓解状态。进行了敏感性、特异性、阳性和阴性预测值（PPV、NPV）以及kappa 分析，以说明不同方法在组水平上定义缓解的关系。

结果

共纳入 705 例患者的评估。根据布尔值定义，有 89 例患者被归类为缓解，根据 ACR/EULAR 建议的 SDAI 定义，有 169 例患者被归类为缓解，根据 RADAI-5，有 154 例患者被归类为缓解。根据所有 3 种定义，有 68 例评估被归类为缓解。在 RADAI-5 缓解的情况下，敏感性为 78%，特异性为 86%，PPV 为 45%，NPV 为 96%，表明根据布尔值定义缓解；而根据 SDAI 定义缓解，敏感性为 60%，特异性为 92%，PPV 为 66%，NPV 为 90%。在根据 SDAI 定义的 ACR/EULAR 缓解的情况下，敏感性为 52%，特异性为 100%，PPV 为 98%，NPV 为 87%，这也表明根据布尔值定义缓解；而根据布尔值定义，敏感性为 98%，特异性为 87%，PPV 为 52%，NPV 为 100%。kappa 统计分析表明，所有 3 种定义均具有良好的一致性。