A new laboratory surrogate (Monocyte Chemotactic Protein-1) for Disease Activity Score28: a favourable indicator for remission in rheumatoid arthritis

Lieh-Bang Liou,Jenn-Haung Lai,Ping-Han Tsai,Chih Feng Tan,Shr-Shian Jang,Ting-Chih Yeh,Yao-Fan Fang

doi:10.1038/s41598-020-65127-5

Abstract

This prospective one-year follow-up study was conducted from 835 visits in 178 rheumatoid arthritis (RA) patients. Tender-/swollen-joint count, Health Assessment Questionnaire Disability Index (HAQ-DI), Disease Activity Score 28-ESR (DAS28-ESR), DAS28-CRP, Simplified Disease Activity Index (SDAI) and DAS28-monocyte chemotactic protein-1 (DAS28-MCP-1) scores were obtained every 3 months. Radiographs of hands and feet were acquired at baseline and one year. We evaluated the correlation and accuracy of activity scores in predicting remission, HAQ-DI changes and radiographic changes. DAS28-MCP-1 correlated strongly with DAS28-ESR, DAS28-CRP and SDAI scores (0.830, 0.899 and 0.931, respectively, with all P < 0.001). Score changes of DAS28-MCP-1 were comparable to those of DAS28-ESR, DAS28-CRP and SDAI in predicting changes in HAQ-DI and bone erosion. DAS28-MCP-1 (<2.2) was better than DAS28-ESR (<2.6) in indicating modified American Rheumatism Association remission and 2011 American College of Rheumatology/European League Against Rheumatism remission (75.61% vs. 36.99% and 81.71% vs. 49.13%, respectively) with odds ratios of 5.28 and 4.62 (both P < 0.001), respectively. We compared DAS28-MCP-1 with SDAI (≦3.3) in indicating remission with odds ratios of 2.63 (P = 0.002) and 0.98, respectively (and DAS28-MCP-1 with DAS28-CRP < 2.5: 1.33 and 0.92). Therefore, DAS28-MCP-1 is useful as an alternative in assessing RA activity.

Highlights

Disease activity score (DAS) was simplified to DAS28 score[1] after its initial implementation and validation in patients with rheumatoid arthritis (RA)[2,3]
We followed up a small group of RA patients further at Month 1, 3 and 6: It revealed that DAS28-MCP-1 correlated significantly with DAS28-ESR17
Acute-phase reactants like erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) can be affected by a complicated array of factors and are produced far from the site of inflammation

Summary

Introduction

Disease activity score (DAS) was simplified to DAS28 score[1] after its initial implementation and validation in patients with rheumatoid arthritis (RA)[2,3]. DAS28-ESR did not accurately discriminate remission from non-remission status[11] and misclassified RA patients with moderate or high disease activity[12]. ESR and CRP values in DAS28 scores were within normal ranges in up to 40% of patients with RA13 To address these limitations, a number of other biomarkers have been studied in RA patients[14,15,16,17]. This study attempted to validate the DAS28-MCP-1 formula against the DAS28-ESR, DAS28-CRP and Simplified Disease Activity Index (SDAI) formulae, by longitudinal correlations (at Month 0, 3, 6, 9 and 12: more remission visits could be included), by comparison through Bland–Altman plots and by means of Health Assessment Questionnaire–Disability Index (HAQ-DI) and radiographic changes

Methods

Results

Conclusion