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RA evaluation

RA evaluation. Prof. Patrick DUREZ Service de Rhumatologie, Cliniques Universitaires Saint Luc, UCL, Bruxelles. Monitoring. Progression of disease Tender and swollen joint counts Acute Phase Reactants VAS physician, patient Morning stiffness Functional disease indices

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RA evaluation

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  1. RA evaluation Prof. Patrick DUREZ Service de Rhumatologie, Cliniques Universitaires Saint Luc, UCL, Bruxelles

  2. Monitoring Progression of disease Tender and swollen joint counts Acute Phase Reactants VAS physician, patient Morning stiffness Functional disease indices Composite index: Disease Activity Score Radiological changes Co morbidities Toxicity 2

  3. Joint Count 66 joints 44 joints 28 joints

  4. Acute Phase Reactants • C-Reactive protein (CRP) • Correlates with disease activity and radiologic progression • One of the most responsive acute phase reactants • Can be elevated in many non-RA related diseases • Erythrocyte sedimentation rate (ESR) • Influenced by non-acute phase response factors • Can be elevated in many non-RA related diseases

  5. Correlation ESR & CRP to disease progression measured by X-ray Category % Patients % With  4 new erosions High CRP* 31 85 High ESR** High CRP 37 47 Low ESR† Low CRP‡ 14 33 High ESR Low CRP 18 0 Low ESR * >4mg/dL ** >30 mm/h † <30 mm/h ‡ <4mg/dL

  6. SF 36 Scale 6

  7. Health Assessment Questionnaire (HAQ) Components

  8. 8 categories 20 questions Quotation 0 to 3 0 = without difficulty; 1 = mild difficulty; 2 = much difficulty or with help; 3 = unable Score HAQ is a mean of the worst score in each of the 8 categories. Total score from 0 to 3. Correlation HAQ-DAS-X-ray progression. HAQ-DI Buchbinder R, et coll. Arthritis Rheum 1995; 38:1568-80 Sullivan FM, et coll. Ann Rheum Dis 1987; 46:598-600 Courvoisier N, et coll.Présenté à l’ACR 2006, Washington, Résumé 377. 8

  9. Drossaers-Bakker et al. Arthritis Rheum 1999;42:1854-1860 9

  10. EUROQOL RAQOL AIMS Grip strength ABILHAND … Reliability Validity Sensitivity to Change Other Specific Health Measurement 10

  11. ACR response criteriaACR20 / ACR50 / ACR70 ≥ 20% / 50% / 70% improvement in • Swollen joint count • Tender joint count • Improvement in at least 3 of the following measures • Patient's global assessment of disease activity • Physician's global assessment of disease activity • Patient's assessment of pain • Acute-phase reactant (ESR, CRP) • Disability (HAQ) Felson DT et al. Arthritis Rheum. 1995; 38: 727-735 Felson DT et al. Arthritis Rheum. 1998; 41: 1564-1570

  12. Simplified Disease Activity Index SDAI SDAI includes : Number Tender Joint Count (0 to 28) + Number Swollen Joint Count (0 à 28) + NRS VAS patient(0 to 10 cm) + NRS VAS physician (0 to 10 cm) + CRP (mg/dL) SDAI Severe 40 Moderate Improvement : Good : > 20 points Moderate : 10-20 points No : < 10 points 20 Low 5 Remission SDAI : Simplified Disease Activity Index Smolen JS, et coll. Rheumatology 2003; 42:244-257.

  13. Clinical Disease Activity Index CDAI CDAI includes : Number Tender Joint Count (0 to 28) + Number Swollen Joint Count (0 à 28) + NRS VAS patient(0 to 10 cm) + NRS VAS physician (0 à10 cm) CDAI Severe Moderate 10 Low 2.8 Remission CDAI : Clinical Disease Activity Index Aletaha D, et coll.Arthritis Res Ther. 2005;7(4):R796-806.

  14. RADAI Please, answer these questions about your arthritis.  1) In general, how active has your arthritis been over the past 6 months?  2) In terms of joint tenderness and swelling, how active is your arthritis today?  • How much arthritis pain do you feel today?   • Were your joints stiff when you woke up today? If yes, how long did this stiffness last? less than 30 minutes 30 minutes to 1 hour 1 – 2 hours 2 – 4 hours more than 4 hours all day 5) Please, indicate the amount of pain you are having today in each of the joints areas listed below.

  15. X-rays evaluation and scoring • Sharp Method (and modified score) • Erosions and joint space narrowing • Genant-Sharp Method • Variable of the Sharp Method (half score) • Larsen Method (and modified score) • Global score on erosions

  16. Modified Sharp Score Scale :0 = normal 1 = doubtful2 = > 50 % normal3 = < 50 % normal or subluxation 4 = ankylosis Total Sharp Score = JSN + JE Joint space narrowing Joint erosions 44 joints 40 joints Scale : 1 = mild modification2 to 4 = size of the erosion 5 = complete destruction van der Heijde DM: Baillieres Clin Rheumatol 1996;10:435-453. 16

  17. Sharp Method % of Joint Eroded Modification 17

  18. Cumulative Probability Plot of Radiographic Outcome

  19. Remission in RA • ACR criteria1 • Morning stiffness < 15 minutes • No fatigue • No joint pain • No synovitis • ESR < 30 • EULAR criteria2 • DAS 44 < 1,6 • DAS 28 < 2,6 • Others3 • SDAI < 3,3 • CDAI < 2,8 1. Pinals RS, et coll. Arthritis Rheum 1981; 24(10):1308-15. 2. Prevoo ML, et coll. Br J Rheumatol 1996; 35(11):1101-5. 3. Geborek P, et coll.Présenté à l’ACR 2006, Washington. Résumé 387.

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