Utility of the HandScan in monitoring disease activity and prediction of clinical response in rheumatoid arthritis patients: an explorative study

Abstract

Objectives: The aims were to determine the ability of the HandScan [assessing inflammation in hand and wrist joints using optical spectral transmission (OST)] to measure RA disease activity longitudinally, compared with DAS28, and to determine whether short-term (i.e. 1 month) changes in the OST score can predict treatment response at 3 or 6 months.

Methods: Participants visited the outpatient clinic before the start of (additional) RA medication and 1, 3 and 6 months thereafter. Disease activity was monitored at each visit with the HandScan and DAS28 in parallel. A mixed effects model with DAS28 as the outcome variable with a random intercept at patient level, visit month and DAS28 one visit earlier was used to evaluate whether changes in the OST score are related to changes in DAS28. Binary logistic regression was used to test the predictive value of short-term changes in the OST score together with the baseline OST score for achievement of treatment response (EULAR or ACR criteria). All models were adjusted for RA stage (early or established).

Results: In total, 64 RA patients were included. One unit change in OST score was found to be related to an average DAS28 change of 0.03 (95% CI: 0.01, 0.06, P = 0.03). When adding OST score as a variable in the longitudinal model, the ability of the model to estimate DAS28 (i.e. explained variance) increased by 2%, to 59%. Neither baseline OST score nor short-term change in OST score was predictive for treatment response at 3 or 6 months.

Conclusion: A longitudinal association of OST score with DAS28 exists, although explained variance is low. The predictive ability of short-term changes in HandScan for treatment response is limited.

Keywords: DMARDs; biological; disease activity; inflammation; optical spectral transmission; rheumatoid arthritis.

Fig. 1

Disease activity measures, functional ability and quality of life over time *Means for DAS28 and OST score and medians for SJC, TJC, HAQ and EQ5D-5L. DAS28: DAS assessing 28 joints; EQ5D-5L: EuroQol five dimensions questionnaire; OST score: optical spectral transmission score; SJC: swollen joint count; TJC: tender joint count.

Fig. 2

Observed DAS28 vs estimated DAS28 (using full model with optical spectral transmission score) DAS28: DAS assessing 28 joints; predicted DAS28: DAS28 as estimated by the model, with optical spectral transmission score, visit month and DAS28 at the previous visit as variables.