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    A modified rheumatoid arthritis disease activity score without acute-phase reactants (mDAS28) for epidemiological research

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    Authors
    Bentley, Mary Jane
    Greenberg, Jeffrey D.
    Reed, George W.
    Student Authors
    Mary J. Bentley
    UMass Chan Affiliations
    Department of Medicine, Division of Preventive and Behavorial Medicine
    Graduate School of Biomedical Sciences, Clinical & Population Health Research Program
    Document Type
    Journal Article
    Publication Date
    2010-08-01
    Keywords
    Acute-Phase Proteins
    Arthritis, Rheumatoid
    Cohort Studies
    Cross-Sectional Studies
    Female
    Health Status
    Humans
    Joints
    Male
    Middle Aged
    Predictive Value of Tests
    Reproducibility of Results
    Rheumatology
    Severity of Illness Index
    Health Services Research
    Musculoskeletal Diseases
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    Link to Full Text
    http://dx.doi.org/10.3899/jrheum.090831
    Abstract
    OBJECTIVE: To develop and validate a modified version of the Disease Activity Score with 28 joint count (mDAS28), for use in epidemiological research, when acute-phase reactant values are unavailable. METHODS: In a cross-sectional development cohort (5729 patients), statistically significant predictors of the logarithm of erythrocyte sedimentation rate (lnESR) were identified. After computation of the mDAS28, a cross-sectional validation cohort (5578 patients) was used to evaluate internal, criterion, and construct validities. The ability of the mDAS28 to discriminate between disease states was also assessed. A second validation cohort (longitudinal, 336 pairs of patient visits) was used to assess sensitivity to change. RESULTS: Significant predictors of lnESR included tender and swollen joints with 28 counts, patient's and physician's assessments of global health, and patient's assessment of pain (visual analog scale 0-100 mm) and a physical function (modified Health Assessment Questionnaire 0-3; mHAQ). Satisfactory internal validity (alpha = 0.72) and strong criterion validity compared to the DAS28, the Simplified Disease Activity Index (SDAI), and the Clinical Disease Activity Index (CDAI) (r = 0.87-0.96) were found. Predictive validity was demonstrated by good correlation with the mHAQ (r = 0.58). The mDAS28 showed substantial agreement with the DAS28, SDAI, and CDAI in discriminating between disease states (kappa = 0.70-0.77) and moderate to substantial agreement between response levels (kappa = 0.52-0.73). Both mDAS28 and DAS28 measures classified patients similarly in remission compared to the SDAI and CDAI. The mDAS28 was superior in detecting change (standardized response mean = 0.58) followed by the DAS28, CDAI, and SDAI. CONCLUSION: The mDAS28 is a valid and sensitive tool to assess disease activity in epidemiological research, as an alternative to the DAS28, when acute-phase reactant values are unavailable.
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/31193
    PubMed ID
    20595282
    Related Resources
    Link to article in PubMed
    Rights
    Citation: J Rheumatol. 2010 Aug 1;37(8):1607-14. Epub 2010 Jul 1. Link to article on publisher's website
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