Rheumatoid Arthritis Disease Activity Index-5: an easy and effective way of monitoring patients with rheumatoid arthritis

Vikram S Tanwar,Harpreet Singh,Sameer Arora,Ankit Kalra,Gagandeep Sukhija,Anjali Saini

doi:10.4103/err.err_16_19

Abstract

ObjectiveTo study the utility of the Rheumatoid Arthritis Disease Activity Index-5 (RADAI-5) as a valid tool for daily rheumatoid arthritis (RA) monitoring and to compare its predictability to assess RA activity with respect to Disease Activity Score 28 (DAS28) and Clinical Disease Activity Index (CDAI).Patients and methodsA total of 100 patients with RA (diagnosed as per American College of Rheumatology 1987 criteria) were enrolled in the study group. Each patient was assessed two times with 3-month interval for disease activity (DA) using DAS28, CDAI, and RADAI-5. Spearman’s correlation coefficient (p) for correlation and kappa for agreement between different activity measures were assessed.ResultsIn our study group, 19% patients were men and 81% patients were women, with male to female ratio of 1 :4.3. Their mean age was 44.4±11.8 years, and their mean disease duration was 67.5±59.8 months. On initial visit, that is, baseline, mean DA as per RADAI-5, DAS28, and CDAI were 5.14±2.17, 5.58±1.55, and 27.96±15.46, respectively, and on follow-up visit, the readings were 3.76±1.92, 4.54±1.41, and 17.67±12.46, respectively. The mean changes in DA at follow-up visit were -1.37 ±2.15 by RADAI-5, -1.04±1.58 by DAS28, and -10.29±15.75 by CDAI. Changes in DA indices correlated significantly with each other with p ranging from 0.8 to 0.9 (P<0.001). An average agreement was found among all three measures at different DA level.ConclusionRADAI-5 seems to be an effective tool with high tendency to assess the changes in RA DA in routine patient care in hospital settings as well as in home-based settings.

Highlights

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease characterized by persistent synovitis of diarthrodial joints often symmetrical in distribution, resulting in pain, stiffness, and loss of function [1]
Rheumatoid Arthritis Disease Activity Index-5 (RADAI-5), a newly developed activity assessment tool, has been evaluated in various studies for disease activity (DA), and it relies on patient-reported outcomes only [8,9,10,11]
Each patient was first assessed for core data set measures, that is, tender joint count (TJC) and swollen joint count (SJC), patient’s global health assessment [patient’s global assessment (PGA) or general health), and evaluator’s global health assessment (EGA) as per visual analog score (VAS) scale, as well as acute-phase reactant − ESR, and the DA measures (DAS28 and Clinical Disease Activity Index (CDAI)) were assessed by using these core data set measures

Summary

Introduction

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease characterized by persistent synovitis of diarthrodial joints often symmetrical in distribution, resulting in pain, stiffness, and loss of function [1]. Several widely used indices [Disease Activity Score (DAS28) and Clinical Disease Activity Index (CDAI)] and activity measures like number of swollen joint count (SJC) and tender joint count (TJC) requires physician’s intervention (to perform joint counts), and cannot be used by patient himself/herself at homebased settings. It has been seen that for prognosis and monitoring the disease, patient questionnaire’s score for functional status appeared to be or even more informative than even a full joint count [7]. Rheumatoid Arthritis Disease Activity Index-5 (RADAI-5), a newly developed activity assessment tool, has been evaluated in various studies for DA, and it relies on patient-reported outcomes only [8,9,10,11].

Methods

Results

Conclusion