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Thresholds for the 28-joint disease activity score (DAS28) using C-reactive protein are lower compared to DAS28 using erythrocyte sedimentation rate in early rheumatoid arthritis

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13

 

  1. Sinai Health System, University of Toronto, Canada. bindee.kuriya@sinaihealthsystem.ca
  2. Division of Epidemiology, University of Toronto, Dalla Lana School of Public Health, Toronto, Canada.
  3. Sinai Health System, University of Toronto, Canada.
  4. Sinai Health System, University of Toronto, Canada.
  5. St. Josephs Health Care, University of Western Ontario, London, Canada.
  6. Université de Sherbrooke, Canada.
  7. Institut de Rhumatologie, Montreal, Canada.
  8. Southlake Regional Health Centre, Newmarket, Canada.
  9. Southlake Regional Health Centre, Newmarket, Canada.
  10. University of Manitoba, Winnipeg, Canada.
  11. Vancouver General Hospital, University of British Columbia, Canada.
  12. Sinai Health System, University of Toronto, Canada.
  13. Sinai Health System, University of Toronto, Canada; and Hospital for Special Surgery, New York, USA.

for the CATCH Investigators

CER10040
2017 Vol.35, N°5
PI 0799, PF 0803
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PMID: 28339365 [PubMed]

Received: 24/10/2016
Accepted : 30/01/2017
In Press: 23/03/2017
Published: 15/09/2017

Abstract

OBJECTIVES:
The 28-Joint Disease Activity Score (DAS28) using C-reactive protein (CRP) and DAS28 using erythrocyte sedimentation rate (DAS28-ESR) may not be interchangeable. We sought to compare and estimate optimal thresholds for the DA28-CRP for use in early rheumatoid arthritis (ERA).
METHODS:
Patients from the Canadian Early Arthritis Cohort with baseline and 12 months’ data for both DAS28-ESR and DAS28-CRP were examined for correlations and differences between DAS28-CRP and DAS28-ESR across their range of values. Receiver operating characteristic analysis identified thresholds for DAS28-CRP that best corresponded to established thresholds for the DAS28-ESR using the total sample, then stratified by age and sex. Agreement between DAS28-CRP and DAS28-ESR thresholds was assessed with the kappa statistic.
RESULTS:
The sample included 995 patients with mean (SD) age of 53.7 (14.5) years, 5.8 (2.9) months of symptom duration and 74% were female. DAS28-CRP and DAS28-ESR scores were highly correlated (r= 0.92, p<0.0001), however DAS28-CRP values were consistently lower than DAS28-ESR values. Calculated thresholds for DAS28-CRP were lower with 2.5 for remission, 2.9 for low disease activity, and 4.6 for high disease activity but showed moderate agreement with the DAS28-ESR thresholds (kappa=0.70).
CONCLUSIONS:
In this large sample of ERA patients, newly estimated thresholds for DAS28-CRP were consistently lower than DAS28-ESR thresholds across the spectrum of disease activity. This may have important clinical implications if inflammatory markers are used interchangeably. Additional external validation of our findings is needed.

Rheumatology Article