类风湿关节炎活动期临床判断
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(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 Rheum.1995;38(6):727-735
Continuous Measures of RA Disease Activity
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 indices • Response criteria for clinical trials • Patient-reported outcome measures • Quantitatively-driven therapy for early RA • Data collection tools
DM van der Heijde et al. J Rheumatol 1993;20:579-81
DAS28:A simplified disease activity score
Simplified disease activity score using 28-joint count -Integrates measures of physical examination, acute phase response, and
• Imaging
- Plain radiographs - Musculoskeletal ultrasound - MRI
Why Assess Joints?
• Primary site of RA disease activity • Persistent synovitis results in
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 < 1.6 = remission
patient self-assessment DAS28=0.56•(Tender 28)1/2 +0.28 •(Swollen 28)1/2 + 0.70 In(ESR)+ 0.014
(Global Health on VAS) Provides absolute indication of RA disease activity on a scale of 0.49 to 9.07 -DAS28 > 5.1 =high disease activity -DAS28 3.2- 5.1= moderate disease activity -DAS28 2.6- 3.2=low disease activity -DAS28 <2.6 = remission
• Disease Activity Score (DAS) • DAS28 • Simplified Disease Activity Index(SDAI)（简化的DAS评分） • Clinical Disease Activity Index(CDAI)（临床DAS评分）
Disease Activity Score (DAS):A continuous measure
-George Bernard Shaw
(1856-1950)
How to quantify RA disease activity
• Clinical composite indices
-DAS / DAS28 -SDAS -CDAI
• Patient-reported outcome
measures
ACR response criteria:the traditional dichotomous benchmark
•Hale Waihona Puke BaiduReported as %improvement, comparing disease activity at two discrete time
points -ACR20 is ≥ 20% improvement -ACR50 is ≥ 50% improvement
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.”
-Joint destruction -Disability
• Goal of treatment (remission) is absence of synovitis • Tender & swollen joint counts are outcome upon which
therapeutic decisions are based
-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 Rheum.1995;38(6):727-735
Continuous Measures of RA Disease Activity
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 indices • Response criteria for clinical trials • Patient-reported outcome measures • Quantitatively-driven therapy for early RA • Data collection tools
DM van der Heijde et al. J Rheumatol 1993;20:579-81
DAS28:A simplified disease activity score
Simplified disease activity score using 28-joint count -Integrates measures of physical examination, acute phase response, and
• Imaging
- Plain radiographs - Musculoskeletal ultrasound - MRI
Why Assess Joints?
• Primary site of RA disease activity • Persistent synovitis results in
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 < 1.6 = remission
patient self-assessment DAS28=0.56•(Tender 28)1/2 +0.28 •(Swollen 28)1/2 + 0.70 In(ESR)+ 0.014
(Global Health on VAS) Provides absolute indication of RA disease activity on a scale of 0.49 to 9.07 -DAS28 > 5.1 =high disease activity -DAS28 3.2- 5.1= moderate disease activity -DAS28 2.6- 3.2=low disease activity -DAS28 <2.6 = remission
• Disease Activity Score (DAS) • DAS28 • Simplified Disease Activity Index(SDAI)（简化的DAS评分） • Clinical Disease Activity Index(CDAI)（临床DAS评分）
Disease Activity Score (DAS):A continuous measure
-George Bernard Shaw
(1856-1950)
How to quantify RA disease activity
• Clinical composite indices
-DAS / DAS28 -SDAS -CDAI
• Patient-reported outcome
measures
ACR response criteria:the traditional dichotomous benchmark
•Hale Waihona Puke BaiduReported as %improvement, comparing disease activity at two discrete time
points -ACR20 is ≥ 20% improvement -ACR50 is ≥ 50% improvement
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.”
-Joint destruction -Disability
• Goal of treatment (remission) is absence of synovitis • Tender & swollen joint counts are outcome upon which
therapeutic decisions are based