A comparative study of clinical composite measures (DAS28, SDAI, CDAI) in patients with rheumatoid arthritis treated with anti-tumor necrosis factor agents

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  • 関節リウマチの臨床的評価法（DAS28，SDAI，CDAI）の比較 ～抗TNF 療法施行例を用いた検討～

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    Although tight control is important in treatment of rheumatoid arthritis (RA), it is unclear which composite measure of RA is best to evaluate clinical disease activity of RA. The aim of this study is to compare four composite measures (DAS28-ESR, DAS28-CRP, SDAI, CDAI) in patients with RA treated with anti-TNF agents. The rates of high disease activity (HDA) were 85.4% using DAS28-ESR, 92.1% using DAS28-CRP, 73.0% using SDAI and 73.0% using CDAI at the time of starting anti-TNF therapy in all cases (n＝89). Significantly more patients were evaluated as HDA using DAS28-ESR and using DAS28-CRP than using SDAI and using CDAI. The rates of HDA were 26.9% using DAS28-ESR,35.9% using DAS28-CRP,14.1% using SDAI and 18.0% using CDAI at the time of last visit in only cases who continued anti-TNF therapy (n＝78). The rates of low disease activity (LDA) were 26.9% using DAS28-ESR, 35.9% using DAS28-CRP, 39.7% using SDAI and 39.7% using CDAI at the time of last visit in only cases who continued anti-TNF therapy (n＝78). Significant fewer patients were evaluated as HDA using SDAI than using DAS28-ESR and using DAS28-CRP. The rates of remission were 16.7% using DAS28-ESR, 21.8% using DAS28-CRP, 12.8% using SDAI and 7.7% using CDAI at the time of last visit in only cases continuing anti-TNF therapy (n＝78). There was a statistically significant difference between the rate of remission using DAS28-CRP and the rate of remission using CDAI. Although all patients were evaluated as LDA using all four measures in the EULAR good response group (n＝21), one case using SDAI and one case using CDAI were evaluated as LDA in the no-response group according to the EULAR criteria (n＝15). These results suggest that (1) DAS28-CRP was most sensitive to reflect the change of disease activity, (2) that it was very difficult to achieve remission evaluated by SDAI or CDAI, (3) that physicians must understand the character of each composite measure for RA and (4) that good response according to the EULAR criteria was a beneficial target to treat RA.

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