Department of Rheumatology and Rehabilitation, Cairo University, Cairo, Egypt.
Department of Rheumatology and Rehabilitation, Zagazig University, Zagazig, Egypt.
Clin Rheumatol. 2017 Oct;36(10):2217-2224. doi: 10.1007/s10067-017-3674-x. Epub 2017 May 22.
The aim of our work was to assess the performance of different Disease Activity Score (DAS) other than DAS-ESR in daily clinical practice in our Egyptian outpatient clinics and also to evaluate the accuracy of European League Against Rheumatism Classification (EULAR) proposed cutoffs for these scores to stratify Egyptian patients into different categories of disease activity. This study is a cross-sectional Egyptian multicenter study. It included 130 rheumatoid arthritis (RA) patients who visited our Rheumatology and Rehabilitation outpatient and inpatient clinics; 80 patients from Cairo University Hospitals and 50 patients from Zagazig University Hospitals. The patients fulfilled the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism Classification criteria for rheumatoid arthritis. Disease Activity Score 28-ESR (DAS28-ESR), DAS28-CRP, Simplified Disease Activity Index (SDAI), and Clinical Disease Activity Index (CDAI) were calculated. A significant positive correlation was found between all three scores and morning stiffness, ESR, Modified Health Assessment Questionnaire (MHAQ), and DAS-ESR. Also, there was a significant negative correlation between DAS-CRP and hemoglobin and a significant positive correlation with CRP. Also, there was a highly significant moderate agreement between DAS-ESR and DAS-CRP using Fleischmann et al. thresholds and also between DAS-ESR and SDAI. While a highly significant fair agreement was found between DAS-ESR and DAS-CRP using DAS-ESR thresholds and between DAS-ESR and CDAI. We conclude that DAS-CRP, SDAI, and CDAI are very useful in representing disease activity in RA patients in our outpatient clinics being well correlated with many markers of disease activity. We recommend huge multicenter studies in Egypt and in different populations to define new cutoff values to optimize their use in clinical setting.
我们的工作目的是评估不同疾病活动评分（DAS）在埃及门诊的日常临床实践中的表现，同时评估欧洲抗风湿病联盟（EULAR）提出的这些评分分类标准的准确性，以将埃及患者分为不同疾病活动类别。本研究是一项埃及多中心的横断面研究。共纳入 130 例类风湿关节炎（RA）患者，他们分别就诊于开罗大学附属医院和扎格齐格大学附属医院的风湿免疫科门诊和住院病房。这些患者符合 2010 年美国风湿病学会（ACR）/欧洲抗风湿病联盟（EULAR）RA分类标准。计算 DAS28-红细胞沉降率（DAS28-ESR）、DAS28- C 反应蛋白（DAS28-CRP）、简化疾病活动指数（SDAI）和临床疾病活动指数（CDAI）。结果显示，所有三种评分与晨僵、红细胞沉降率、健康评估问卷简化版（MHAQ）和 DAS-ESR 均呈显著正相关。同时，DAS-CRP 与血红蛋白呈显著负相关，与 C 反应蛋白呈显著正相关。此外，Fleischmann 等人提出的 DAS-ESR 和 DAS-CRP 之间存在高度显著的中度一致性，DAS-ESR 和 SDAI 之间也存在显著的中度一致性。然而，DAS-ESR 界值下的 DAS-ESR 和 DAS-CRP 之间以及 DAS-ESR 界值下的 DAS-ESR 和 CDAI 之间存在高度显著的公平一致性。我们得出结论，DAS-CRP、SDAI 和 CDAI 在我们的门诊中非常有用，可以代表 RA 患者的疾病活动度，与许多疾病活动标志物密切相关。我们建议在埃及和不同人群中进行大型多中心研究，以确定新的截断值，优化其在临床中的应用。
