Disease Activity Score 28-ESR bears a similar relationship to treatment decisions across different rheumatologists, but misclassification is too frequent to replace physician judgement

Taylor, W; Harrison, Andrew A.; Highton, John; Chapman, Peter T.; Stamp, Lisa K.; Dockerty, John D.; McQueen, Fiona; Jones, Peter; Ching, Daniel; Porter, Duncan; Rajapakse, C. N. A.; Rudge, S. R.; Taylor, Graeme; Kumar, Sharath; Macedo, Thuane Lopes; Hoy, Matthias

doi:10.1093/rheumatology/ken004

Cited by 22 publications

(12 citation statements)

References 10 publications

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“…Our data show that a low DAS44 threshold in treat-to-target protocols poses challenges in clinical practice, because the measure is not reliable in patients with low disease activity, mostly because of its sensitivity to small changes in ESR and global health scores, when joint scores are low or zero 29. One option may be to add a biomarker in the assessment of disease activity.…”

Section: Discussionmentioning

confidence: 94%

Intensive combination treatment regimens, including prednisolone, are effective in treating patients with early rheumatoid arthritis regardless of additional etanercept: 1-year results of the COBRA-light open-label, randomised, non-inferiority trial

et al. 2014

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Section: Discussionmentioning

confidence: 94%

Intensive combination treatment regimens, including prednisolone, are effective in treating patients with early rheumatoid arthritis regardless of additional etanercept: 1-year results of the COBRA-light open-label, randomised, non-inferiority trial

et al. 2014

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“…This among other factors has led to the debate of whether the cut-off point for DAS28 remission reflects true clinical remission [34,35]. In the therapeutic decision making, rheumatologists do not always rely solely on the DAS28 [36], but also other markers of inflammation and/or progression [31,37] and patients' characteristics [38] are taken into account. The DAS28 is suggested to be a tool to guide decision making in RA; nevertheless, it cannot always replace the clinical judgement in the context of an individual patient.…”

Section: Discussionmentioning

confidence: 99%

Adherence to a treat-to-target strategy in early rheumatoid arthritis: results of the DREAM remission induction cohort

et al. 2012

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IntroductionClinical trials have demonstrated that treatment-to-target (T2T) is effective in achieving remission in early rheumatoid arthritis (RA). However, the concept of T2T has not been fully implemented yet and the question is whether a T2T strategy is feasible in daily clinical practice. The objective of the study was to evaluate the adherence to a T2T strategy aiming at remission (Disease Activity Score in 28 joints (DAS28) < 2.6) in early RA in daily practice. The recommendations regarding T2T included regular assessment of the DAS28 and advice regarding DAS28-driven treatment adjustments.MethodsA medical chart review was performed among a random sample of 100 RA patients of the DREAM remission induction cohort. At all scheduled visits, it was determined whether the clinical decisions were compliant to the T2T recommendations.ResultsThe 100 patients contributed to a total of 1,115 visits. The DAS28 was available in 97.9% (1,092/1,115) of the visits, of which the DAS28 was assessed at a frequency of at least every three months in 88.3% (964/1,092). Adherence to the treatment advice was observed in 69.3% (757/1,092) of the visits. In case of non-adherence when remission was present (19.5%, 108/553), most frequently medication was tapered off or discontinued when it should have been continued (7.2%, 40/553) or treatment was continued when it should have been tapered off or discontinued (6.2%, 34/553). In case of non-adherence when remission was absent (42.1%, 227/539), most frequently medication was not intensified when an intensification step should have been taken (34.9%, 188/539). The main reason for non-adherence was discordance between disease activity status according to the rheumatologist and DAS28.ConclusionsThe recommendations regarding T2T were successfully implemented and high adherence was observed. This demonstrates that a T2T strategy is feasible in RA in daily clinical practice.

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“…The Disease Activity Score in 28 joints (DAS28) was used to assess disease activity at each visit. Disease activity was graded by the following classification criteria: DAS28 ≤2.6 = clinical remission, ≤3.2 = mild disease activity, ≤5.2 = moderate disease activity, and >5.2 = severe disease activity (14).…”

Section: Methodsmentioning

confidence: 99%

Evaluation of a novel 7‐joint ultrasound score in daily rheumatologic practice: A pilot project

Backhaus¹,

Ohrndorf²,

Kellner³

et al. 2009

Arthritis & Rheumatism

390

312

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Objective. To introduce a new standardized ultrasound score based on 7 joints of the clinically dominant hand and foot (German US7 score) implemented in daily rheumatologic practice. Methods. The ultrasound score included the following joints of the clinically dominant hand and foot: wrist, second and third metacarpophalangeal and proximal interphalangeal, and second and fifth metatarsophalangeal joints. Synovitis and synovial/tenosynovial vascularity were scored semiquantitatively (grade 0 -3) by gray-scale (GS) and power Doppler (PD) ultrasound. Tenosynovitis and erosions were scored for presence. The scoring range was 0 -27 for GS synovitis, 0 -39 for PD synovitis, 0 -7 for GS tenosynovitis, 0 -21 for PD tenosynovitis, and 0 -14 for erosions. Patients with arthritis were examined at baseline and after the start or change of disease-modifying antirheumatic drug (DMARD) and/or tumor necrosis factor ␣ (TNF␣) inhibitor therapy 3 and 6 months later. C-reactive protein level, erythrocyte sedimentation rate, rheumatoid factor, anti-cyclic citrullinated peptide, Disease Activity Score in 28 joints (DAS28), and radiographs of the hands and feet were performed. Results. One hundred twenty patients (76% women) with rheumatoid arthritis (91%) and psoriatic arthritis (9%) were enrolled. In 52 cases (43%), erosions were seen in radiography at baseline. Patients received DMARDs (41%), DMARDs plus TNF␣ inhibitors (41%), or TNF␣ inhibitor monotherapy (18%). At baseline, the mean DAS28 was 5.0 and the synovitis scores were 8.1 in GS ultrasound and 3.3 in PD ultrasound. After 6 months of therapy, the DAS28 significantly decreased to 3.6 (⌬ ‫؍‬ 1.4), and the GS and PD ultrasound scores significantly decreased to 5.5 (؊32%) and 2.0 (؊39%), respectively. Conclusion. The German US7 score is a viable tool for examining patients with arthritis in daily rheumatologic practice because it significantly reflects therapeutic response.

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Disease Activity Score 28-ESR bears a similar relationship to treatment decisions across different rheumatologists, but misclassification is too frequent to replace physician judgement

Cited by 22 publications

References 10 publications

Intensive combination treatment regimens, including prednisolone, are effective in treating patients with early rheumatoid arthritis regardless of additional etanercept: 1-year results of the COBRA-light open-label, randomised, non-inferiority trial

Intensive combination treatment regimens, including prednisolone, are effective in treating patients with early rheumatoid arthritis regardless of additional etanercept: 1-year results of the COBRA-light open-label, randomised, non-inferiority trial

Adherence to a treat-to-target strategy in early rheumatoid arthritis: results of the DREAM remission induction cohort

Evaluation of a novel 7‐joint ultrasound score in daily rheumatologic practice: A pilot project

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