当疾病活动评分仅基于主观参数时，28个关节疾病活动评分- C反应蛋白在类风湿关节炎患者亚组中的可靠性可能被高估：一项横断面探索性研究。
The Reliability of Disease Activity Score in 28 Joints-C-Reactive Protein Might Be Overestimated in a Subgroup of Rheumatoid Arthritis Patients, When the Score Is Solely Based on Subjective Parameters: A Cross-sectional, Exploratory Study.
作者信息
Jensen Hansen Inger Marie, Asmussen Andreasen Rikke, van Bui Hansen Mark Nam, Emamifar Amir
机构信息
From the *Department of Rheumatology, Odense University Hospital, Svendborg Hospital, Svendborg; and †Faculty of Health Sciences, University of Southern Denmark, Odense; ‡DANBIO Registry, Copenhagen; and §Department of Technology and Innovation, University of Southern Denmark, Odense, Denmark.
出版信息
J Clin Rheumatol. 2017 Mar;23(2):102-106. doi: 10.1097/RHU.0000000000000469.
BACKGROUND
Disease Activity Score in 28 Joints (DAS28) is a scoring system to evaluate disease activity and treatment response in rheumatoid arthritis (RA). A DAS28 score of greater than 3.2 is a well-described limit for treatment intensification; however, the reliability of DAS28 might be overestimated.
OBJECTIVE
The aim of this study was to evaluate the reliability of DAS28 in RA, especially focusing on a subgroup of patients with a DAS28 score of greater than 3.2.
METHODS
Data from RA patients registered in the local part of Danish DANBIO Registry were collected in May 2015. Patients were categorized into 2 groups: First, those with DAS28 >3.2 with at least one swollen joint (SJ) or elevated C-reactive protein (CRP) ("objective group"), and second, patients with a DAS28 >3.2 who had no SJ, and CRP values were within the reference range ("subjective group"). Disease Activity Score in 28 Joints, Clinical Disease Activity Index, and Health Assessment Questionnaire scores were calculated for each group. We defined new score, DAS28 subjective, to focus on subjective parameters.
RESULTS
Two hundred thirty patients were included; 198 (86.1%) and 32 (13.9%) patients were in the objective and subjective groups, respectively. Patients in the subjective group had lower mean values of DAS28 (P < 0.001) and Evaluator Global Assessment (P < 0.001) with less common immunoglobulin M rheumatoid factor (P < 0.001) and anti-cyclic citrullinated peptide positivity (P = 0.02) and contrarily higher mean values of tender joints (P = 0.04) and DAS28 based on subjective parameters (P = 0.003) compared with the objective group.
CONCLUSIONS
Rheumatoid arthritis scoring systems should be used cautiously in patients who are considered for treatment intensification. Patients with central sensitization and psychological problems and those with false-positive diagnosis of RA are at high risk of overtreatment.
背景
28个关节疾病活动评分（DAS28）是一种用于评估类风湿关节炎（RA）疾病活动度和治疗反应的评分系统。DAS28评分大于3.2是治疗强化的一个明确界限；然而，DAS28的可靠性可能被高估。
目的
本研究旨在评估DAS28在类风湿关节炎中的可靠性，尤其关注DAS28评分大于3.2的患者亚组。
方法
2015年5月收集了丹麦DANBIO注册中心本地登记的类风湿关节炎患者的数据。患者被分为两组：第一组，DAS28>3.2且至少有一个肿胀关节（SJ）或C反应蛋白（CRP）升高（“客观组”）；第二组，DAS28>3.2但无SJ且CRP值在参考范围内（“主观组”）。计算每组的28个关节疾病活动评分、临床疾病活动指数和健康评估问卷评分。我们定义了新的评分DAS28主观评分，以关注主观参数。
结果
共纳入230例患者；客观组和主观组分别有198例（86.1%）和32例（13.9%）患者。主观组患者的DAS28均值（P<0.001）和评估者整体评估均值（P<0.001）较低，免疫球蛋白M类风湿因子阳性率较低（P<0.001），抗环瓜氨酸肽阳性率较低（P=0.02），相反，与客观组相比，压痛关节均值（P=0.04）和基于主观参数的DAS28均值较高（P=0.003）。
结论
在考虑强化治疗的类风湿关节炎患者中，应谨慎使用类风湿关节炎评分系统。存在中枢敏化和心理问题的患者以及类风湿关节炎假阳性诊断的患者有过度治疗的高风险。
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