How much does Disease Activity Score in 28 joints ESR and CRP calculations underestimate disease activity compared with the Simplified Disease Activity Index?
Objectives Disease Activity Score in 28 joints calculated with C-reactive protein (DAS28-CRP) is used instead of erythrocyte sedimentation rate (DAS28-ESR) to assess rheumatoid arthritis disease activity; however, values for remission and low disease activity (LDA) for DAS28-CRP have not been valida...
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| Veröffentlicht in: | Annals of the rheumatic diseases 2015-06, Vol.74 (6), p.1132-1137 |
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| container_title | Annals of the rheumatic diseases |
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| creator | Fleischmann, Roy van der Heijde, Désirée Koenig, Andrew S Pedersen, Ronald Szumski, Annette Marshall, Lisa Bananis, Eustratios |
| description | Objectives Disease Activity Score in 28 joints calculated with C-reactive protein (DAS28-CRP) is used instead of erythrocyte sedimentation rate (DAS28-ESR) to assess rheumatoid arthritis disease activity; however, values for remission and low disease activity (LDA) for DAS28-CRP have not been validated. American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) guidelines suggest remission should be calculated by Simplified Disease Activity Index (SDAI) rather than DAS28-ESR. We examined values of remission and LDA of DAS28-CRP that correspond to the respective cut-off points for DAS28-ESR and SDAI from five clinical trials. Methods DAS28-CRP cut-offs that best correspond to DAS28-ESR remission |
| doi_str_mv | 10.1136/annrheumdis-2013-204920 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1808687343</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1808687343</sourcerecordid><originalsourceid>FETCH-LOGICAL-b487t-4946dfe6fe4aa8cad922c0745d6a6f7cb249ff1a35bb8333bcef3751d83ab9043</originalsourceid><addsrcrecordid>eNqNkU1vVCEUhonR2LH6F5TEjZtRvi5wV6YZq23SRNPRNeHykWFyL4zAtfbP9LeWyUyN0YVuIAee85DDC8ArjN5iTPk7HWPeuHmyoSwJwrQtrCfoEVhgxmWrOHoMFgghumQ9FyfgWSnbViKJ5VNwQjrMaEfIAtxdpBs4zWYDbXIFfgjF6eLgmanhR6i3cG1SdjBESCTcphBrgefra6ijhavrL9Do0cyjriHFAudoXXalhklXB-1RpR9UJk07nZ2FN6FuYN04uA7Tbgw-tLO_Hr5ssp_vn4MnXo_FvTjup-Dbx_Ovq4vl1edPl6uzq-XApKhtRsatd9w7prU02vaEGCRYZ7nmXpiBsN57rGk3DJJSOhjnqeiwlVQPPWL0FLw5eHc5fZ_bDGoKxbhx1NGluSgskeRSUEb_jXKJsOiFEA19_Qe6TXOObRCF232PEUF7oThQJqdSsvNql9sX5luFkdqnrX5LW-3TVoe0W-fLo38eJmd_9T3E2wByAIZp-9_WezA0uvs</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1777910203</pqid></control><display><type>article</type><title>How much does Disease Activity Score in 28 joints ESR and CRP calculations underestimate disease activity compared with the Simplified Disease Activity Index?</title><source>MEDLINE</source><source>BMJ Journals - NESLi2</source><creator>Fleischmann, Roy ; van der Heijde, Désirée ; Koenig, Andrew S ; Pedersen, Ronald ; Szumski, Annette ; Marshall, Lisa ; Bananis, Eustratios</creator><creatorcontrib>Fleischmann, Roy ; van der Heijde, Désirée ; Koenig, Andrew S ; Pedersen, Ronald ; Szumski, Annette ; Marshall, Lisa ; Bananis, Eustratios</creatorcontrib><description>Objectives Disease Activity Score in 28 joints calculated with C-reactive protein (DAS28-CRP) is used instead of erythrocyte sedimentation rate (DAS28-ESR) to assess rheumatoid arthritis disease activity; however, values for remission and low disease activity (LDA) for DAS28-CRP have not been validated. American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) guidelines suggest remission should be calculated by Simplified Disease Activity Index (SDAI) rather than DAS28-ESR. We examined values of remission and LDA of DAS28-CRP that correspond to the respective cut-off points for DAS28-ESR and SDAI from five clinical trials. Methods DAS28-CRP cut-offs that best correspond to DAS28-ESR remission <2.6 and LDA ≤3.2 were obtained by cumulative distribution plots, receiver operating curves and maximum concordance and averaged for each approach, treatment group and study. Level of agreement between DAS28-CRP and DAS28-ESR remission and LDA cut-offs was compared against each other and versus SDAI remission ≤3.3 and LDA ≤11. Results Percentage of patients who achieved remission and LDA by DAS28-ESR cut-offs was greater for DAS28-CRP versus DAS28-ESR regardless of patient population or treatment group. Discordance between CRP and ESR cut-offs ranged from 4%–26% and 8%–23% for remission and LDA, respectively, and 19%–40% and 6%–11% for DAS28-CRP versus SDAI, respectively. Estimated (range) remission and LDA thresholds were 2.4 (2.2–2.6) and 2.9 (2.6–3.3), 1.9 (1.6–2.2) and 3.1 (3.1–3.3) and 2.2 (1.1–2.9) and 3.6 (3.4–4.0) for DAS28-CRP versus DAS28-ESR, DAS28-CRP versus SDAI and DAS28-ESR versus SDAI, respectively. Conclusions DAS28-CRP underestimates disease activity when using cut-off points validated for DAS28-ESR; therefore, DAS28-ESR cut-off values should not be applied to DAS28-CRP. Although DAS28-CRP and DAS28-ESR cut-offs for LDA ≤3.2 correspond to SDAI LDA, neither corresponds well to SDAI remission.</description><identifier>ISSN: 0003-4967</identifier><identifier>EISSN: 1468-2060</identifier><identifier>DOI: 10.1136/annrheumdis-2013-204920</identifier><identifier>PMID: 25143522</identifier><identifier>CODEN: ARDIAO</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Antirheumatic Agents - therapeutic use ; Arthritis, Rheumatoid - blood ; Arthritis, Rheumatoid - diagnosis ; Arthritis, Rheumatoid - drug therapy ; Blood Sedimentation ; C-Reactive Protein - analysis ; Clinical medicine ; Clinical trials ; Clinical Trials as Topic ; Humans ; Laboratories ; Outcome Assessment (Health Care) - standards ; Remission Induction ; Rheumatoid arthritis ; ROC Curve ; Severity of Illness Index ; Studies</subject><ispartof>Annals of the rheumatic diseases, 2015-06, Vol.74 (6), p.1132-1137</ispartof><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</rights><rights>Copyright: 2015 Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b487t-4946dfe6fe4aa8cad922c0745d6a6f7cb249ff1a35bb8333bcef3751d83ab9043</citedby><cites>FETCH-LOGICAL-b487t-4946dfe6fe4aa8cad922c0745d6a6f7cb249ff1a35bb8333bcef3751d83ab9043</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttp://ard.bmj.com/content/74/6/1132.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttp://ard.bmj.com/content/74/6/1132.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>114,115,314,780,784,3196,23571,27924,27925,77600,77631</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25143522$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fleischmann, Roy</creatorcontrib><creatorcontrib>van der Heijde, Désirée</creatorcontrib><creatorcontrib>Koenig, Andrew S</creatorcontrib><creatorcontrib>Pedersen, Ronald</creatorcontrib><creatorcontrib>Szumski, Annette</creatorcontrib><creatorcontrib>Marshall, Lisa</creatorcontrib><creatorcontrib>Bananis, Eustratios</creatorcontrib><title>How much does Disease Activity Score in 28 joints ESR and CRP calculations underestimate disease activity compared with the Simplified Disease Activity Index?</title><title>Annals of the rheumatic diseases</title><addtitle>Ann Rheum Dis</addtitle><description>Objectives Disease Activity Score in 28 joints calculated with C-reactive protein (DAS28-CRP) is used instead of erythrocyte sedimentation rate (DAS28-ESR) to assess rheumatoid arthritis disease activity; however, values for remission and low disease activity (LDA) for DAS28-CRP have not been validated. American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) guidelines suggest remission should be calculated by Simplified Disease Activity Index (SDAI) rather than DAS28-ESR. We examined values of remission and LDA of DAS28-CRP that correspond to the respective cut-off points for DAS28-ESR and SDAI from five clinical trials. Methods DAS28-CRP cut-offs that best correspond to DAS28-ESR remission <2.6 and LDA ≤3.2 were obtained by cumulative distribution plots, receiver operating curves and maximum concordance and averaged for each approach, treatment group and study. Level of agreement between DAS28-CRP and DAS28-ESR remission and LDA cut-offs was compared against each other and versus SDAI remission ≤3.3 and LDA ≤11. Results Percentage of patients who achieved remission and LDA by DAS28-ESR cut-offs was greater for DAS28-CRP versus DAS28-ESR regardless of patient population or treatment group. Discordance between CRP and ESR cut-offs ranged from 4%–26% and 8%–23% for remission and LDA, respectively, and 19%–40% and 6%–11% for DAS28-CRP versus SDAI, respectively. Estimated (range) remission and LDA thresholds were 2.4 (2.2–2.6) and 2.9 (2.6–3.3), 1.9 (1.6–2.2) and 3.1 (3.1–3.3) and 2.2 (1.1–2.9) and 3.6 (3.4–4.0) for DAS28-CRP versus DAS28-ESR, DAS28-CRP versus SDAI and DAS28-ESR versus SDAI, respectively. Conclusions DAS28-CRP underestimates disease activity when using cut-off points validated for DAS28-ESR; therefore, DAS28-ESR cut-off values should not be applied to DAS28-CRP. Although DAS28-CRP and DAS28-ESR cut-offs for LDA ≤3.2 correspond to SDAI LDA, neither corresponds well to SDAI remission.</description><subject>Antirheumatic Agents - therapeutic use</subject><subject>Arthritis, Rheumatoid - blood</subject><subject>Arthritis, Rheumatoid - diagnosis</subject><subject>Arthritis, Rheumatoid - drug therapy</subject><subject>Blood Sedimentation</subject><subject>C-Reactive Protein - analysis</subject><subject>Clinical medicine</subject><subject>Clinical trials</subject><subject>Clinical Trials as Topic</subject><subject>Humans</subject><subject>Laboratories</subject><subject>Outcome Assessment (Health Care) - standards</subject><subject>Remission Induction</subject><subject>Rheumatoid arthritis</subject><subject>ROC Curve</subject><subject>Severity of Illness Index</subject><subject>Studies</subject><issn>0003-4967</issn><issn>1468-2060</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNqNkU1vVCEUhonR2LH6F5TEjZtRvi5wV6YZq23SRNPRNeHykWFyL4zAtfbP9LeWyUyN0YVuIAee85DDC8ArjN5iTPk7HWPeuHmyoSwJwrQtrCfoEVhgxmWrOHoMFgghumQ9FyfgWSnbViKJ5VNwQjrMaEfIAtxdpBs4zWYDbXIFfgjF6eLgmanhR6i3cG1SdjBESCTcphBrgefra6ijhavrL9Do0cyjriHFAudoXXalhklXB-1RpR9UJk07nZ2FN6FuYN04uA7Tbgw-tLO_Hr5ssp_vn4MnXo_FvTjup-Dbx_Ovq4vl1edPl6uzq-XApKhtRsatd9w7prU02vaEGCRYZ7nmXpiBsN57rGk3DJJSOhjnqeiwlVQPPWL0FLw5eHc5fZ_bDGoKxbhx1NGluSgskeRSUEb_jXKJsOiFEA19_Qe6TXOObRCF232PEUF7oThQJqdSsvNql9sX5luFkdqnrX5LW-3TVoe0W-fLo38eJmd_9T3E2wByAIZp-9_WezA0uvs</recordid><startdate>20150601</startdate><enddate>20150601</enddate><creator>Fleischmann, Roy</creator><creator>van der Heijde, Désirée</creator><creator>Koenig, Andrew S</creator><creator>Pedersen, Ronald</creator><creator>Szumski, Annette</creator><creator>Marshall, Lisa</creator><creator>Bananis, Eustratios</creator><general>BMJ Publishing Group LTD</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9-</scope><scope>K9.</scope><scope>LK8</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>M7P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>7T5</scope><scope>H94</scope></search><sort><creationdate>20150601</creationdate><title>How much does Disease Activity Score in 28 joints ESR and CRP calculations underestimate disease activity compared with the Simplified Disease Activity Index?</title><author>Fleischmann, Roy ; van der Heijde, Désirée ; Koenig, Andrew S ; Pedersen, Ronald ; Szumski, Annette ; Marshall, Lisa ; Bananis, Eustratios</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b487t-4946dfe6fe4aa8cad922c0745d6a6f7cb249ff1a35bb8333bcef3751d83ab9043</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Antirheumatic Agents - therapeutic use</topic><topic>Arthritis, Rheumatoid - blood</topic><topic>Arthritis, Rheumatoid - diagnosis</topic><topic>Arthritis, Rheumatoid - drug therapy</topic><topic>Blood Sedimentation</topic><topic>C-Reactive Protein - analysis</topic><topic>Clinical medicine</topic><topic>Clinical trials</topic><topic>Clinical Trials as Topic</topic><topic>Humans</topic><topic>Laboratories</topic><topic>Outcome Assessment (Health Care) - standards</topic><topic>Remission Induction</topic><topic>Rheumatoid arthritis</topic><topic>ROC Curve</topic><topic>Severity of Illness Index</topic><topic>Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fleischmann, Roy</creatorcontrib><creatorcontrib>van der Heijde, Désirée</creatorcontrib><creatorcontrib>Koenig, Andrew S</creatorcontrib><creatorcontrib>Pedersen, Ronald</creatorcontrib><creatorcontrib>Szumski, Annette</creatorcontrib><creatorcontrib>Marshall, Lisa</creatorcontrib><creatorcontrib>Bananis, Eustratios</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection (ProQuest)</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Science Database (ProQuest)</collection><collection>Biological Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><jtitle>Annals of the rheumatic diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fleischmann, Roy</au><au>van der Heijde, Désirée</au><au>Koenig, Andrew S</au><au>Pedersen, Ronald</au><au>Szumski, Annette</au><au>Marshall, Lisa</au><au>Bananis, Eustratios</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>How much does Disease Activity Score in 28 joints ESR and CRP calculations underestimate disease activity compared with the Simplified Disease Activity Index?</atitle><jtitle>Annals of the rheumatic diseases</jtitle><addtitle>Ann Rheum Dis</addtitle><date>2015-06-01</date><risdate>2015</risdate><volume>74</volume><issue>6</issue><spage>1132</spage><epage>1137</epage><pages>1132-1137</pages><issn>0003-4967</issn><eissn>1468-2060</eissn><coden>ARDIAO</coden><abstract>Objectives Disease Activity Score in 28 joints calculated with C-reactive protein (DAS28-CRP) is used instead of erythrocyte sedimentation rate (DAS28-ESR) to assess rheumatoid arthritis disease activity; however, values for remission and low disease activity (LDA) for DAS28-CRP have not been validated. American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) guidelines suggest remission should be calculated by Simplified Disease Activity Index (SDAI) rather than DAS28-ESR. We examined values of remission and LDA of DAS28-CRP that correspond to the respective cut-off points for DAS28-ESR and SDAI from five clinical trials. Methods DAS28-CRP cut-offs that best correspond to DAS28-ESR remission <2.6 and LDA ≤3.2 were obtained by cumulative distribution plots, receiver operating curves and maximum concordance and averaged for each approach, treatment group and study. Level of agreement between DAS28-CRP and DAS28-ESR remission and LDA cut-offs was compared against each other and versus SDAI remission ≤3.3 and LDA ≤11. Results Percentage of patients who achieved remission and LDA by DAS28-ESR cut-offs was greater for DAS28-CRP versus DAS28-ESR regardless of patient population or treatment group. Discordance between CRP and ESR cut-offs ranged from 4%–26% and 8%–23% for remission and LDA, respectively, and 19%–40% and 6%–11% for DAS28-CRP versus SDAI, respectively. Estimated (range) remission and LDA thresholds were 2.4 (2.2–2.6) and 2.9 (2.6–3.3), 1.9 (1.6–2.2) and 3.1 (3.1–3.3) and 2.2 (1.1–2.9) and 3.6 (3.4–4.0) for DAS28-CRP versus DAS28-ESR, DAS28-CRP versus SDAI and DAS28-ESR versus SDAI, respectively. Conclusions DAS28-CRP underestimates disease activity when using cut-off points validated for DAS28-ESR; therefore, DAS28-ESR cut-off values should not be applied to DAS28-CRP. Although DAS28-CRP and DAS28-ESR cut-offs for LDA ≤3.2 correspond to SDAI LDA, neither corresponds well to SDAI remission.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>25143522</pmid><doi>10.1136/annrheumdis-2013-204920</doi><tpages>6</tpages></addata></record> |
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| ispartof | Annals of the rheumatic diseases, 2015-06, Vol.74 (6), p.1132-1137 |
| issn | 0003-4967 1468-2060 |
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| source | MEDLINE; BMJ Journals - NESLi2 |
| subjects | Antirheumatic Agents - therapeutic use Arthritis, Rheumatoid - blood Arthritis, Rheumatoid - diagnosis Arthritis, Rheumatoid - drug therapy Blood Sedimentation C-Reactive Protein - analysis Clinical medicine Clinical trials Clinical Trials as Topic Humans Laboratories Outcome Assessment (Health Care) - standards Remission Induction Rheumatoid arthritis ROC Curve Severity of Illness Index Studies |
| title | How much does Disease Activity Score in 28 joints ESR and CRP calculations underestimate disease activity compared with the Simplified Disease Activity Index? |
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