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

2022; Public Library of Science; Volume: 17; Issue: 9 Linguagem: Inglês

10.1371/journal.pone.0273789

1932-6203

Isabela Araújo Santos, Renê Donizeti Ribeiro de Oliveira, Sérgio Couto Luna de Almeida, Ana Beatriz Vargas‐Santos, Rodrigo Balbino Chaves Amorim, Ana Paula Monteiro Gomides, Cleandro Pires de Albuquerque, Manoel Barros Bértolo, Maria Fernanda Brandão de Resende Guimarães, Maria Raquel da Costa Pinto, Gustavo Gomes Resende, Rina Dalva Neubarth Giorgi, Nathalia de Carvalho Saciloto, Sebastião Cézar Radominski, Fernanda Maria Borghi, Karina Rossi Bonfiglioli, Henrique Carriço da Silva, Maria de Fátima Lobato da Cunha Sauma, Ivânio Alves Pereira, Gláucio Ricardo Werner de Castro, Claiton Viegas Brenol, Ricardo Machado Xavier, Lícia Maria Henrique da Mota, Paulo Louzada‐Júnior, Geraldo da Rocha Castelar Pinheiro,

Chronic Lymphocytic Leukemia Research

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.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.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.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%.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.