Are the C-reactive protein values and erythrocyte sedimentation rate equivalent when estimating the 28-joint disease activity score in rheumatoid arthritis?

Rheumatology Service, Hospital Universitario de la Princesa, Madrid, Spain.
Clinical and experimental rheumatology (Impact Factor: 2.72). 09/2008; 26(5):769-75.
Source: PubMed


A formula for calculating disease activity score with 28 joint counts (DAS28) with C-reactive protein (CRP) instead of the erythrocyte sedimentation rate (ESR) has been proposed.
Here we analyze the factors that contribute to the differences in the DAS28 when calculated using either the ESR (DAS28-ESR) or the CRP values (DAS28-CRP).
We analyzed the data from 587 visits made by 220 patients with early arthritis. The age at the onset of the disease was 51+/-16 years old and 76.3% of the patients were women. The disease evolution at the first visit was 5 months and at each visit information related to several variables was collected, including that necessary to calculate the DAS28-ESR and DAS28-CRP. We defined a new variable DIFDAS=DAS28-ESR-DAS28-CRP to analyze which independent variables account for differences between the two indexes.
There was a correlation between the two indexes of 0.91 (p<0.0001), although the DAS28-ESR value obtained was higher than that of DAS28-CRP at approximately 90% of the visits. Significantly, the difference between both indexes was higher than 0.6 in 44% of the visits studied. A multivariate analysis showed that female gender and disease duration were associated with the higher values obtained for DAS28-ESR when compared to those of DAS28-CRP.
Our data show that DAS28-ESR and DAS28-CRP are not fully equivalent, because the former usually produces higher values. This finding is particularly relevant in females and patients with a long disease duration.

Download full-text


Available from: Isidoro González-Álvaro, May 08, 2014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective To provide a reference to rheumatologists and to those involved in the treatment of RA who are using, or about to use biologic therapy.Methods Recommendations were developed following a nominal group methodology and based on systematic reviews. The level of evidence and grade of recommendation were classified according to the model proposed by the Center for Evidence Based Medicine at Oxford. The level of agreement was established through Delphi technique.ResultsWe have produced recommendations on the use of the seven biologic agents available for RA in our country. The objective of treatment is to achieve the remission of the disease as quickly as possible. Indications and nuances regarding the use of biologic therapy were reviewed as well as the evaluation that should be performed prior to administration and the follow up of patients undergoing this therapy.Conclusions We present an update on the SER recommendations for the use of biologic therapy in patients with RA.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Monitoring of disease activity using DAS28 is more effective than routine RA care, but the ESR measurement is time consuming. Alternative rapid ESR determination methods can be used but effects on DAS28 classification are unknown. Alternative rapid ESR methods, including the Starrsed 30-minute mode and Alifax Roller Test-1TH, were compared to the Westergren method. Mean difference, limits of agreement (LoA) and intraclass correlation coefficients (ICC) were calculated. Based on these results, using a longitudinal design the percentage of DAS28 misclassification for the Alifax Roller Test-1TH was measured. The Alifax showed acceptable ICCs, but LoA were large. ICC was 0.67 (0.56-0.76), LoA -43;34. The longitudinal study on the Alifax (n=125) showed an ICC of 0.93, a kappa of 0.61, but disease activity was misclassified in 26% of the patients. Use of the ESR from the previous visit resulted in comparable levels of misclassification. ESR measured by automated analysers like Alifax show acceptable ICC but LoA are large compared to the Westergren ESR. The Alifax Roller Test-1TH is very rapid but DAS28 misclassification is considerable and even as large as when using the ESR of the previous visit.
    Clinical and experimental rheumatology 01/2010; 28(4):477-82. · 2.72 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objetivo Valorar las diferencias de respuesta al tratamiento mediante DAS28 calculado mediante velocidad de sedimentación globular (VSG) y proteína C reactiva teniendo en cuenta el género del paciente y analizar el comportamiento individual de cada uno de sus componentes en una cohorte de pacientes de artritis precoz en el área 2 de la Comunidad de Madrid. Pacientes y métodos Se estudiaron un total de 134 pacientes (77,6% mujeres) que cumplían criterios del Colegio Americano de Reumatología para el diagnóstico de artritis reumatoide del registro de artritis precoz del Hospital de La Princesa. En dicho registro se realizaron 4 visitas protocolizadas en las que se recogen de forma sistemática los datos necesarios para calcular el DAS28 con VSG y proteína C reactiva, así como el tratamiento prescrito a los pacientes. Se analizaron las diferencias por género en la respuesta al tratamiento mediante ambos índices compuestos, así como de las variables que los componen y la valoración de la enfermedad por el médico. Resultados Las mujeres presentaron mayor actividad de la enfermedad y discapacidad al inicio del seguimiento. A pesar de que estas recibieron un tratamiento más intenso, su valor promedio de DAS28 no llegó a igualarse con el de los hombres a lo largo del seguimiento. Por el contrario, la valoración de la enfermedad por parte del paciente y del médico sí llegó a igualarse. Al analizar los componentes del DAS28 por separado, se observó que esta discordancia era debida principalmente a las variables VSG y recuento de articulaciones dolorosas. Conclusiones La VSG y el recuento de articulaciones dolorosas causan un sesgo en la evaluación de la actividad de la artritis reumatoide con el DAS28 que puede afectar a la evaluación de la respuesta al tratamiento.
    Reumatología Clínica 05/2010; 6(3). DOI:10.1016/j.reuma.2009.09.014
Show more