Article

OBJECTIVES: To evaluate and compare four composite indices for assessing the
activity of rheumatoid arthritis (RA). METHODS: We conducted a systematic
literature review by searching Medline via PubMed and Embase and Cochrane
databases for articles published up to March 2009. We selected studies that
directly compared at least two of the four composite indices. The DAS (Disease
Activity Score), DAS28, Simplified Disease Activity Index (SDAI) and Clinical
Disease Activity Index (CDAI) were evaluated in terms of reproducibility,
construct validity, discriminative performance, and sensitivity to change.
RESULTS: We included 61 articles. The only study that directly compared the
intraobserver reproducibility of the DAS28, SDAI, and CDAI found comparable
intraclass correlation coefficients ranging from 0.85 to 0.89. Concordance among
indices was good (kappa values of approximately 0.7), except between the DAS28
and the other indices in definition of remission (kappa 0.48-0.63). The indices
had good construct validity by their similar fair-to-good correlations with the
Health Assessment Questionnaire (HAQ) score and structural damage. Discriminative
performance was comparable and satisfactory for treatment changes or remission
according to the American College of Rheumatology (ACR). Two studies evaluated
the sensitivity to change of the SDAI and CDAI; both indices detected a
difference between responders and non-responders according to ACR definitions.
CONCLUSION: The DAS, DAS28, SDAI, and CDAI are valid tools for evaluating the
activity of RA. The DAS28 is less conservative in defining remission than are the
other three indices. Longitudinal studies of individual patients are needed to
confirm these results.
CI - Copyright A(c) 2011 Societe francaise de rhumatologie. Published by Elsevier SAS.
All rights reserved.

Langue : ANGLAIS