Yokogawa Naoto, Shimada Kota, Sugii Shoji, Komiya Akiko, Matsui Toshihiro, Nishino Jinju, Tohma Shigeto
Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
Sagamihara National Hospital, National Hospital Organization, Sagamihara, Japan.
ACR Open Rheumatol. 2020 May;2(5):301-306. doi: 10.1002/acr2.11142. Epub 2020 May 3.
We aimed to standardize the definition of low disease activity in rheumatoid arthritis (RA) using the Outcome Measures in Rheumatology (OMERACT) group's proposed definition of minimal disease activity.
Based on a nationwide RA database, we proposed new Boolean low disease activity criteria using OMERACT's core set definition of minimal disease activity that requires the fulfillment of at least five of the following seven core set measures: a pain score of 2 or less, a swollen joint count (SJC28) of 1 or fewer, a tender joint count of 1 or fewer, a Health Assessment Questionnaire score of 0.5 or less, a Physician's Global Assessment score of 1.5 or less, a Patient's Global Assessment score of 2 or less, and an erythrocyte sedimentation rate (ESR) of 20 mm/h or less. Using receiver operating characteristic analysis, we determined the cutoffs for the Simplified Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI), Routine Assessment of Patient Index Data 3 (RAPID3), and the Disease Activity Score in 28 joints (DAS28)-ESR.
Of 8298 patients, 56.2% met the proposed Boolean low disease activity criteria. We determined an SDAI score of 5.5 or less and a CDAI score of 5 or less to be the new cutoffs, and we chose a DAS28 of 2.85 or less (the original cutoff for DAS-based minimal disease activity) and a RAPID3 score of 6 or less (the original cutoff for RAPID3-based low disease activity) with or without a swollen joint count (SJC) (SJC of 2 or fewer) as the cutoffs for DAS28 and RAPID3. The agreement between the new cutoffs for DAS28 of 2.85 or less vs. CDAI score of 5 or less, CDAI score of 5 or less vs. RAPID3 score of 6 or less (with SJC of 2 or fewer), and DAS28 of 2.85 or less vs. RAPID3 score of 6 or less (with SJC of 2 or fewer), was 0.619, 0.612 (0.702), and 0.474 (0.531), respectively.
OMERACT's minimal disease activity definition may be used to standardize the criteria for low disease activity.
我们旨在使用风湿病结局评估（OMERACT）小组提出的最小疾病活动度定义，来规范类风湿关节炎（RA）低疾病活动度的定义。
基于一个全国性的RA数据库，我们使用OMERACT最小疾病活动度的核心集定义提出了新的布尔型低疾病活动度标准，该标准要求满足以下七个核心集指标中的至少五项：疼痛评分2分或更低、肿胀关节计数（SJC28）为1个或更少、压痛关节计数为1个或更少、健康评估问卷评分0.5分或更低、医生整体评估评分1.5分或更低、患者整体评估评分2分或更低，以及红细胞沉降率（ESR）为20mm/h或更低。使用受试者工作特征分析，我们确定了简化疾病活动指数（SDAI）、临床疾病活动指数（CDAI）、患者指数数据3的常规评估（RAPID3）以及28个关节的疾病活动评分（DAS28）-ESR的临界值。
在8298例患者中，56.2%符合提出的布尔型低疾病活动度标准。我们确定SDAI评分5.5分或更低以及CDAI评分5分或更低为新的临界值，并且我们选择DAS28为2.85分或更低（基于DAS的最小疾病活动度的原始临界值）以及RAPID3评分6分或更低（基于RAPID3的低疾病活动度的原始临界值），无论是否有肿胀关节计数（SJC）（SJC为2个或更少）作为DAS28和RAPID3的临界值。DAS28为2.85分或更低与CDAI评分5分或更低之间、CDAI评分5分或更低与RAPID3评分6分或更低（SJC为2个或更少）之间以及DAS28为2.85分或更低与RAPID3评分6分或更低（SJC为2个或更少）之间的一致性分别为0.619、0.612（0.702）和0.474（0.531）。
OMERACT的最小疾病活动度定义可用于规范低疾病活动度的标准。
