类风湿关节炎活动期临床判断

,类风湿关节炎活动度临床判断,Clinical Assessment of Rheumatoid Arthritis Disease Activity(Partly quoted from Jonathan Kay, MD),Content,Why quantify RA disease activity?Composite disease activity indicesResponse criteria for clinical trialsPatient-reported outcome measuresQuantitatively-driven therapy for early RAData 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.”-George Bernard Shaw(1856-1950),How to quantify RA disease activity,Clinical composite indices-DAS / DAS28 -SDAS-CDAIPatient-reported outcome measuresImaging- Plain radiographs- Musculoskeletal ultrasound- MRI,Primary site of RA disease activityPersistent synovitis results in -Joint destruction -DisabilityGoal of treatment (remission) is absence of synovitisTender & swollen joint counts are outcome 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 trialsNot directly applicable to clinical practice DT Felson et al. Arthritis Rheum.1995;38(6):727-735,ACR response criteria:the traditional dichotomous benchmark,Disease Activity Score (DAS)DAS28Simplified Disease Activity Index(SDAI)（简化的DAS评分）Clinical Disease Activity Index(CDAI)（临床DAS评分）,Continuous Measures of RA Disease Activity,DAS=0.54(Tender 44)1/2 +0.06 (Swollen 66)1/2 + 0.33 In(ESR)+ 0.007 (Global Health on VAS) （44个压痛关节、66个肿胀关节）Provides absolute indication of RA disease activity on a scale of 1 to 9-DAS 3.6 = high disease activity-DAS 2.4- 3.6 = moderate disease activity-DAS 1.6- 2.4= low disease activity-DAS 5.1 =high disease activity-DAS28 3.2- 5.1= moderate disease activity-DAS28 2.6- 3.2=low disease activity-DAS28 26 = high disease activity-SDAI 11.1-26 = moderate disease activity-SDAI 3.3-11= low disease activity-SDAI 22 = high disease activity-CDAI 10.1-22 = moderate disease activity-SDAI 2.8-10 = low disease activity-SDAI 12.0 = high disease activity-RAPID3 6.1-12.0 = moderate disease activity-RAPID3 3.1-6.0 = low disease activity-RAPID3 0-3.0 = remissionCorrelates with DAS28 & with CDAI in clinical practice T Pincus et al. Rheum Dis Clin N Am. 2009;35:773-778,Quantitatively-Driven Therapy for Early RA: Clinical trials,TICORA(Tight control for rheumatoid arthritis)Best(Behandel-Strategien)CAMERA-Evaluated the clinical and radiographic outcomes of different treatment protocols for RA-18-to 24-month blinded, controlled trials-Patients with early (2 yrs) or recent onset(2 yrs) active RAGrigor et al. Lancet. 2004;364:263-269Goekoop-Ruiterman et al. Arthritis Rheum. 2005;52:3381-90;Verstappen et al. Ann Rheum Dis 2007;6