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Multicenter Study
. 2022 Sep 29;17(9):e0273789.
doi: 10.1371/journal.pone.0273789. eCollection 2022.

Comparison of rheumatoid arthritis composite disease activity indices and residual activity in a Brazilian multicenter study- REAL study

Isabela Araújo Santos  1 , Renê Donizeti Ribeiro de Oliveira  1 , Sergio Couto Luna Almeida  1 , Ana Beatriz Vargas-Santos  2 , Rodrigo Balbino Chaves Amorim  2 , Ana Paula Monteiro Gomides  3 , Cleandro Pires de Albuquerque  3 , Manoel Barros Bertolo  4 , Maria Fernanda Brandão Resende Guimarães  5 , Maria Raquel da Costa Pinto  5 , Gustavo Gomes Resende  5 , Rina Dalva Neubarth Giorgi  6 , Nathalia de Carvalho Saciloto  6 , Sebastião Cezar Radominski  7 , Fernanda Maria Borghi  8 , Karina Rossi Bonfiglioli  9 , Henrique Carrico da Silva  9 , Maria de Fatima L da Cunha Sauma  10 , Ivanio Alves Pereira  11 , Glaucio Ricardo Werner de Castro  12 , Claiton Viegas Brenol  13 , Ricardo Machado Xavier  13 , Licia Maria Henrique Mota  3 , Paulo Louzada-Junior  1 , Geraldo da Rocha Castelar-Pinheiro  2
Affiliations
Multicenter Study

Comparison of rheumatoid arthritis composite disease activity indices and residual activity in a Brazilian multicenter study- REAL study

Isabela Araújo Santos et al. PLoS One. .

Abstract

Introduction: Rheumatoid arthritis (RA) composite disease activity indices have become handy tools in daily clinical practice and crucial in defining remission or low disease activity, the main target of the RA treatment. However, there is no definition of the best index to assess disease activity in clinical practice.

Objectives: To compare the residual activity among the indices with the ACR/EULAR remission criteria (Boolean method) to identify the most feasible for assessing remission in daily practice, also considering correlation and concordance, sensibility, and specificity.

Patients and methods: We selected 1116 patients with established RA from the real-life rheumatoid arthritis study database-REAL. The composite disease activity indices-DAS28-ESR, DAS28-CRP, SDAI, and CDAI-and their components were compared to the Boolean method to identify residual activity using binomial regression. The indices were analyzed for correlation and agreement using the Spearman index and weighted kappa. The chi-square test evaluated sensibility and specificity for remission based on the Boolean method.

Results: DAS28-CRP overestimated remission and confirmed higher residual activity than SDAI and CDAI. The indices showed good correlation and agreement, with a better relationship between SDAI and CDAI (k:0,88). CDAI and SDAI showed higher sensitivity and specificity for remission based on the Boolean method. CDAI was performed in 99% of patients, while DAS28 and SDAI were completed in approximately 85%.

Conclusions: Although all composite indices of activity can be used in clinical practice and showed good agreement, CDAI and SDAI have better performance in evaluating remission based on the Boolean method, showing less residual activity and higher sensibility and specificity. In addition, CDAI seems to be more feasible for disease activity evaluation in daily clinical practice, especially in developing countries.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Distribution of patients according to disease activity.
DAS28-CRP: Disease Activity Score 28- C reactive protein; DAS28-ESR: Disease Activity Score 28—erythrocyte sedimentation rate; SDAI: Simplified Activity Index; CDAI: Clinical Activity Index.
Fig 2
Fig 2. Correlation among the composite disease activity indices.
See this image and copyright information in PMC

References

    1. Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. Lancet. 2016;388: 2023–2038. doi: 10.1016/S0140-6736(16)30173-8 - DOI - PubMed
    1. Smolen JS, Aletaha D, Barton A, Burmester GR, Emery P, Firestein GS, et al.. Rheumatoid arthritis. Nat Rev Dis Prim. 2018;4: 1–23. doi: 10.1038/nrdp.2018.1 - DOI - PubMed
    1. Marques-Neto JF, Gonçalves ET, Langen LFOB, Cunha Mfl, Radominski S OS et al.. Multicentric study of the prevalence of adult rheumatoid arthritis in Brazilian population samples. Rev Bras Reum. 1993;33: 167–73. Available: http://www.scielo.br/scielo.php?script=sci_nlinks&ref=000223&pid=S0482-5...
    1. Cross M, Smith E, Hoy D, Carmona L, Wolfe F, Vos T, et al.. The global burden of rheumatoid arthritis: Estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73: 1316–1322. doi: 10.1136/annrheumdis-2013-204627 - DOI - PubMed
    1. de Andrade NPB, da Silva Chakr RM, Xavier RM, Viecceli D, Correa RHB, de Oliveira Filho CM, et al.. Long-term outcomes of treat-to-target strategy in established rheumatoid arthritis: a daily practice prospective cohort study. Rheumatol Int. 2017;37: 993–997. doi: 10.1007/s00296-017-3695-4 - DOI - PubMed

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