文档介绍：类风湿关节炎活动度临床判断
Clinical Assessment of Rheumatoid Arthritis Disease Activity
杨敏
Content
为什么要对RA活动度进行量化?
Response criteria for clinical trials
Patient-reported e measures
Quantitatively-driven therapy for early RA
Data collection tools
Shaw on Measurement
“The only man who behaved sensibly was my tailor; he took my measure anew every time he saw me, whilst all the rest went on with their old measurements and expected them to fit me.”
-e Bernard Shaw
(1856-1950)
How to quantify RA disease activity
posite indices
-DAS / DAS28
-SDAS
-CDAI
Patient-reported e measures
Imaging
-Plain radiographs
-Musculoskeletal ultrasound
-MRI
Primary site of RA disease activity
Persistent synovitis results in
-Joint destruction
-Disability
Goal of treatment (remission) is absence of synovitis
Tender & swollen joint counts are e upon which therapeutic decisions are based
Why Assess Joints?
Reported as %improvement, comparing disease activity at two discrete time points
-ACR20 is ≥ 20% improvement
-ACR50 is ≥ 50% improvement
(ACR50 responders include ACR20 responders)
-ACR70 is ≥ 70% improvement
(ACR70 responders include ACR20 and ACR50 responders)
Used to maximally discriminate effective treatment from placebo treatment in clinical trials
Not directly applicable to clinical practice
DT Felson et al. Arthritis ;38(6):727-735
ACR response criteria:the traditional dichotomous benchmark
Disease Activity Score (DAS)
DAS28
Simplified Disease Activity Index(SDAI)
Clinical Disease Activity Index(CDAI)
Continuous Measures of RA Disease Activity
DAS=•(Tender 44)1/2 + •(Swollen 66)1/2 + In(ESR)+ (Global Health on VAS)
Provides absolute indication of RA disease activity on a scale of 1 to 9
-DAS > = high disease activity
-DAS - = moderate disease activity
-DAS - = low disease activity
-DAS < = remission
DM van der Heijde et al. J Rheumatol 1993;20:579-81
Disease Activity Score (DAS):A continuous measure
Simplified disease