Abstract
ObjectivesImaging of joint inflammation provides a standard against which to derive an updated DAS for RA. Our objectives were to develop and validate a DAS based on reweighting the DAS28 components to maximize association with US-assessed synovitis.MethodsEarly RA patients from two observational cohorts (n = 434 and n = 117) and a clinical trial (n = 59) were assessed at intervals up to 104 weeks from baseline; all US scans were within 1 week of clinical exam. There were 899, 163 and 183 visits in each cohort. Associations of combined US grey scale and power Doppler scores (GSPD) with 28 tender joint count and 28 swollen joint count (SJC28), CRP, ESR and general health visual analogue scale were examined in linear mixed model regressions. Cross-validation evaluated model predictive ability. Coefficients learned from training data defined a re-weighted DAS28 that was validated against radiographic progression in independent data (3037 observations; 717 patients).ResultsOf the conventional DAS28 components only SJC28 and CRP were associated with GSPD in all three development cohorts. A two-component model including SJC28 and CRP outperformed a four-component model (R2 = 0.235, 0.392, 0.380 vs 0.232, 0.380, 0.375, respectively). The re-weighted two-component DAS28CRP outperformed conventional DAS28 definitions in predicting GSPD (Δtest log-likelihood <−2.6, P < 0.01), Larsen score and presence of erosions.ConclusionA score based on SJC28 and CRP alone demonstrated stronger associations with synovitis and radiographic progression than the original DAS28 and should be considered in research on pathophysiological manifestations of early RA. Implications for clinical management of RA remain to be established.
Highlights
IACON Specialist Registrars and Clinical Fellows: Edith Villeneuve, Sudipto Das, Sarah Horton, Sarah Mackie, Rebecca Thomas, Lesley Ann Bissell, Chadi Rakieh, Zoe Ash, Sarah Twigg, Laura Coates, Fahad Fazal, Laura Hunt, Esme Ferguson, Sara Else, Gui Tran, Ahmed Zayat, Giuseppina Abignano, Md Yuzaiful Md Yusof, Radhika Ragunath, Hannah Mathieson, Chitra Salem-Ramakumaran, Hanna Gul, Mahwish Mahmood IACON Nursing Staff: Pauline Fitzgerald, Matthew Robinson, Jason Ward, Beverly Wells, David Pickles, Oliver Wordsworth, Christine Thomas, Alison McManus, Lynda Bailey, Linda Gray, Kate Russell, Jayne Davies IACON Laboratory and Support Staff: Diane Corscadden, Karen Henshaw, Stephen Martin, James Robinson, Agata Burksa, Sarah Fahy, Jill Halsted-Rastrick, Ged Connolly-Thompson, Jonathan Thompson, Ian Weatherill, Andrea Paterson IACON Radiology team: Laura Horton, Alwyn Jackson, Richard Hodgso
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In IACON, a General Electric E9 machine was used with 15-6 and 18ʹ8 MHz linear array transducers
Summary
IACON Specialist Registrars and Clinical Fellows: Edith Villeneuve, Sudipto Das, Sarah Horton, Sarah Mackie, Rebecca Thomas, Lesley Ann Bissell, Chadi Rakieh, Zoe Ash, Sarah Twigg, Laura Coates, Fahad Fazal, Laura Hunt, Esme Ferguson, Sara Else, Gui Tran, Ahmed Zayat, Giuseppina Abignano, Md Yuzaiful Md Yusof, Radhika Ragunath, Hannah Mathieson, Chitra Salem-Ramakumaran, Hanna Gul, Mahwish Mahmood IACON Nursing Staff: Pauline Fitzgerald, Matthew Robinson, Jason Ward, Beverly Wells, David Pickles, Oliver Wordsworth, Christine Thomas, Alison McManus, Lynda Bailey, Linda Gray, Kate Russell, Jayne Davies IACON Laboratory and Support Staff: Diane Corscadden, Karen Henshaw, Stephen Martin, James Robinson, Agata Burksa, Sarah Fahy, Jill Halsted-Rastrick, Ged Connolly-Thompson, Jonathan Thompson, Ian Weatherill, Andrea Paterson IACON Radiology team: Laura Horton, Alwyn Jackson, Richard Hodgso. Reuse Items deposited in White Rose Research Online are protected by copyright, with all rights reserved unless indicated otherwise. This is indicated by the licence information on the White Rose Research Online record for the item.
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