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Rheumatology Advance Access originally published online on April 24, 2009
Rheumatology 2009 48(6):686-690; doi:10.1093/rheumatology/kep054
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© The Author 2009. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Evaluation of composite measures of treatment response without acute-phase reactants in patients with rheumatoid arthritis

Jeffrey D. Greenberg1, Leslie R. Harrold2, Mary J. Bentley2, Joel Kremer3, George Reed2 and Vibeke Strand4

1Department of Rheumatology, New York University Hospital for Joint Diseases, New York, NY, 2Department of Medicine, University of Massachusetts Medical School, Worcester, MA, 3Department of Medicine, Division of Rheumatology, Albany Medical College, The Center for Rheumatology, Albany, NY and 4Department of Medicine, Division of Immunology/Rheumatology, Stanford University School of Medicine, Palo Alto, CA, USA.

Correspondence to: Jeffrey D. Greenberg, Department of Rheumatology, New York University Hospital for Joint Diseases, 301 East 17th Street, suite 1410, New York, NY 10003, USA. E-mail: jeffrey.greenberg{at}nyumc.org


  Abstract

Objectives. To evaluate composite measures of response without acute-phase reactants in RA patients. Specifically, Clinical Disease Activity Index (CDAI)-derived response criteria were compared with the European League Against Rheumatism (EULAR) response criteria, and the modified ACR (mACR) response criteria were compared to the ACR response criteria.

Methods. Data from 10 108 RA patients enrolled in the Consortium of Rheumatology Researchers of North America registry were examined, including 649 patients initiating DMARD therapy. CDAI cut-off points for disease activity levels and responses were derived using receiver operating characteristic curves with the DAS28 and EULAR response criteria as gold standards. The {kappa}-statistics were applied to assess agreement between CDAI-derived and EULAR-defined responses, as well as ACR20 and ACR50 with mACR20- and mACR50-defined responses, respectively.

Results. For the components of the EULAR response, the derived CDAI cut-off points for DAS28 levels of 3.2 and 5.1 were 7.6 and 19.6, respectively. The derived CDAI cut-off points were 4.3 and 10.0 for DAS28 changes of 0.6 and 1.2, respectively. There were moderate to substantial agreements between CDAI-derived and EULAR responses ({kappa} = 0.57–0.71). Agreement of ACR20 and ACR50 with mACR20 and mACR50 responses, respectively, was excellent ({kappa} = 0.88–0.95).

Conclusions. Agreement between composite measures of response without acute-phase reactants and standard measures ranged from moderate to excellent. The mACR20 and mACR50 criteria as well as CDAI-derived response criteria, can serve as composite measures of response in clinical practice and research settings without access to acute-phase reactants.

KEY WORDS: Rheumatoid arthritis, Acute-phase reactants, Response criteria

Submitted 16 September 2008; revised version accepted 13 February 2009.
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