Rheumatoid Arthritis Disease Activity Index Scores Research Articles

Performance of the Rheumatoid Arthritis Disease Activity Index in the Assessment of Disease Activity in Rheumatoid Arthritis-Findings From the REAL Study.

Although telemedicine use has been under discussion for decades, this topic has gained unprecedented importance during the COVID-19 pandemic. The Rheumatoid Arthritis Disease Activity Index (RADAI) is a user-friendly tool, fully self-administered, to assess rheumatoid arthritis (RA) disease activity. The aim of this study was to compare the performance of RADAI with other disease activity indices, functional status, and inflammatory markers in a large cohort of RA patients. We assessed the concurrent validity of RADAI against Clinical Disease Activity Index (CDAI), Disease Activity Score in 28 Joints-C-reactive protein, Disease Activity Score in 28 Joints-erythrocyte sedimentation rate, Simplified Disease Activity Index, and physician assessment of disease activity and the correlation of RADAI with Health Assessment Questionnaire-Disability Index and inflammatory markers at the REAL Study baseline. We also evaluated the correlation of the change in RADAI and the change in CDAI over a 6-month follow-up. From the 1115 patients included in the REAL Study, 1113 had RADAI scores in the first assessment. At baseline, correlations between RADAI and other disease activity indices were strong, ranging from 0.64 (comparison with physician assessment) to 0.79 (comparison with CDAI). Correlation between the change in RADAI score over the 6 months of follow-up and the change in CDAI score over the same period was moderate/strong for the overall group and within the stratified analyses. The strong correlation of RADAI with other well-established tools for disease activity measurement reassures its use with RA patients' follow-up, especially in this new era of telemedicine.

Homeopathic Treatment of Rheumatoid Arthritis: An Open, Observational Trial

Abstract Background Rheumatological complaints including rheumatoid arthritis (RA) are frequently encountered conditions in homeopathy practice. On account of progressive destruction and disability of the joints, and troublesome side effects and dissatisfaction with the mainstream therapies, homeopathy remains one of the most sought-after therapies; however, it remained under-researched systematically. Aim of this trial was to evaluate the possible role of homeopathic treatment in RA by determining changes in severity of complaints and quality of life. Materials and Methods An open observational trial was performed on 50 patients suffering from RA (classified as per 2010 ACR/EULAR criteria) at National Institute of Homoeopathy, Kolkata and were assessed over 4 months of treatment. Disease Activity Score-28 (DAS28) and Rheumatoid Arthritis Disease Activity Index (RADAI) were used as the primary and secondary outcome measures respectively. Individualised medicines were prescribed on the basis of homeopathic principles. Results Six patients dropped out; 44 completed the trial. Intention-to-treat sample (n = 50) was analysed in the end. There were statistically significant reductions in both DAS28 score (6.8 ± 1.0 vs. 6.1 ± 1.2; mean reduction 0.7, 95% CI: 0.4–0.9, p < 0.001) and RADAI score (6.6 ± 1.8 vs. 5.2 ± 1.9; mean reduction 1.4, 95% CI: 1.0–1.9, p < 0.001) over 4 months of individualised homeopathic treatment. Conclusion Individualised homeopathic medicines seemed to produce promising treatment effects by reducing DAS28 and RADAI scores significantly over 4 months. Further randomised trials are warranted with enhanced methodological rigor (Trial registration: CTRI/2017/06/008848).

The Impact of Frailty on Changes in Physical Function and Disease Activity Among Adults With Rheumatoid Arthritis.

ObjectiveReduced physical function and frailty are common in rheumatoid arthritis (RA). However, relationships between frailty and changes in physical function and disease activity over time in RA are unknown. We tested whether frailty is a risk factor for worsening patient‐reported physical function and disease activity in RA.MethodsAdults from a longitudinal RA cohort (N = 124) participated. By using an established frailty definition, individuals with three or more of the following deficits were considered frail: 1) body mass index less than or equal to 18.5, 2) low grip strength, 3) severe fatigue, 4) slow 4‐m walking speed, and 5) low physical activity. Individuals with one to two or zero deficits were considered “pre‐frail” or “robust,” respectively. Physical function and RA disease activity were assessed by the Health Assessment Questionnaire (HAQ) and Rheumatoid Arthritis Disease Activity Index (RADAI), respectively, at baseline and follow‐up 2 years later. Regression analyses modeled associations of frailty status with change in HAQ and RADAI scores between baseline and follow‐up with and without controlling for covariates. Associations of individual frailty components with change in HAQ and RADAI scores were also examined.ResultsAmong adults with RA, baseline frailty status predicted significant increases, or worsening, in HAQ (β: 0.4; 95% confidence interval: 0.1‐0.8; P < 0.01) but not RADAI scores (β: 0.5; 95% confidence interval: −0.4 to 1.5; P > 0.05) between baseline and follow‐up in fully adjusted models. Fatigue was an important contributor to this effect.ConclusionFrailty may be an important risk factor for reduced physical function over time in RA. Future studies should address whether interventions to reduce frailty improve physical function in RA.

The Self-Administered Rheumatoid Arthritis Disease Activity Index (RADAI) is Less Accurate than DAS28-CRP as a Disease Activity Measure in Pregnancy.

ObjectiveDisease Activity Score 28 (DAS28)–using the C‐reactive protein (CRP) level has been validated to determine disease activity in rheumatoid arthritis (RA) patients during pregnancy. A self‐administered questionnaire like Rheumatoid Arthritis Disease Activity Index (RADAI) has practical advantages over DAS28‐CRP, and in this study, we aimed to validate the RADAI for use during pregnancy.MethodsPatients were derived from a prospective cohort on RA and pregnancy (Pregnancy‐induced Amelioration of Rheumatoid Arthritis study). To validate the RADAI as a disease activity measure, the disease course over time and the disease activity states were compared with the DAS28‐CRP. Furthermore, the RADAI was compared with DAS28‐CRP in predicting fertility and pregnancy outcomes. Finally, to test construct validity, correlation of both RADAI and DAS28‐CRP with a biomarker (galactosylation of immunoglobulin G [IgG]) were determined and compared.ResultsIn total, 269 patients were analyzed in this study. Mean RADAI scores showed a great decline in disease activity in the first trimester compared with DAS28‐CRP (mean RADAI, −1.13; mean, DAS28‐CRP, −0.04). Correlations between DAS28‐CRP and RADAI scores were moderate to good (0.44 < ρ < 0.71). Agreement in disease states was low (0.26 < κ < 0.51). Time to pregnancy was different between disease states according to DAS28‐CRP (P = 0.03), but not according to RADAI (P = 0.56). Only DAS28‐CRP could predict birthweight (DAS28‐CRP β‐0.17, P = 0.04; RADAI β‐0.09, P = 0.10). Both DAS28‐CRP and RADAI were associated with galactosylation of IgG at specific time points, but only change in DAS28‐CRP was correlated with change in galactosylation of IgG from preconception to pregnancy.ConclusionThe RADAI could not be validated as a disease activity measure during pregnancy. DAS28‐CRP remains the gold standard of measuring disease activity in pregnancy.

Association Between the Use of Oral Contraceptives and Patient-Reported Outcomes in an Early Arthritis Cohort.

To evaluate the association between exposure to oral contraceptives (OCs) and clinical outcomes in an early arthritis cohort. Female patients with early inflammatory arthritis, ages 18-60 years, who were enrolled in an early arthritis cohort and had no exposure to hormone replacement were studied (n = 273). Associations between OC exposure (current/past/never) and disease activity, treatment, and patient-reported outcomes, including the Rheumatoid Arthritis Impact of Disease Score (RAID), the Rheumatoid Arthritis Disease Activity Index (RADAI), the Profile of Mood and Discomfort (PROFAD), and the Hannover Functional Assessment (FFbH), were studied over 2 years. Linear mixed models adjusted for age, body mass index, parity, smoking, and education were used. Eighteen percent of patients had never used OCs, 63% had used OCs in the past, and 19% currently used OCs. After adjustment, the current/past OC use was associated with better RAID, PROFAD, RADAI, and FFbH scores at 12 months (P < 0.05 for all) compared to never use. Longitudinally over 2 years, the mean RAID scores were significantly better in women with current/past OC use (P < 0.001). Actual inflammatory markers were not associated with OC use. Glucocorticoids were used by a higher percentage of OC never users than by current/past users (P = 0.08), especially in patients with impaired function (FFbH <70: odds ratio 4.2 [95% confidence interval 1.6-11]). For past as well as current use, OCs seem to moderate patient-reported outcomes in inflammatory arthritis. Protective effects may be induced via central nervous pathways rather than through the suppression of peripheral inflammation.

SAT0460 Patient self-report joint count, rheumatoid arthritis disease activity index (RADAI), on a multidimensional health assessment questionnaire (MDHAQ) is informative in patients with rheumatic diseases other than rheumatoid arthritis

BackgroundA patient self-report joint count, rheumatoid arthritis disease activity index (RADAI),1 is correlated significantly with tender and swollen joint counts performed by a health professional in rheumatoid arthritis (RA) patients2....

AB0321 Unfavourable body composition is associated with inflammation in patients with rheumatoid arthritis

BackgroundDisease activity is thought to play a pivotal role in the development of changes in body composition in patients with chronic inflammatory diseases. However, few data concerning body composition in...

AB0172 Assessment of disease activity in rheumatoid arthritis by routine assessment of rheumatoid arthritis disease activity index (radai) and its relation with disease activity score 28 (das28), clinical disease activity index (cdai) and simplified disease acti

BackgroundEvaluation of disease activity is essential in decision of the treatment and monitoring the therapies in rheumatoid arthritis (RA). Rheumatoid Arthritis Disease Activity Index (RADAI) appears as an attractive form...

Patient self‐report RADAI (Rheumatoid Arthritis Disease Activity Index) joint counts on an MDHAQ (Multidimensional Health Assessment Questionnaire) in usual care of consecutive patients with rheumatic diseases other than rheumatoid arthritis

To analyze a patient self-report joint count from the Rheumatoid Arthritis Disease Activity Index (RADAI) on a Multidimensional Health Assessment Questionnaire (MDHAQ) in a cohort of consecutive patients seen in usual rheumatology care with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), osteoarthritis (OA), psoriatic arthritis (PsA), and gout. Each patient completed an MDHAQ, which included a RADAI, at each visit in one usual care setting. In order to include a physician measure, a random visit at which there was a recorded physician global estimate was selected for each of 465 patients (174 patients with RA, 75 with SLE, 113 with OA, 53 with PsA, and 50 patients with gout). The RADAI was analyzed for total scores (range 0-48), number of involved joint groups (range 0-16), and each specific joint group, and then compared in the 5 diagnostic groups to one another and to other MDHAQ measures and the Routine Assessment of Patient Index Data 3 (RAPID3). In patients with RA, SLE, OA, PsA, and gout, mean RADAI scores (range 0-48) were 12.4, 6.5, 10.1, 6.7, and 2.7, respectively. The mean numbers of involved joint groups (range 0-16) were 6.9, 3.8, 4.8, 4.5, and 1.7, respectively, and the median numbers were 6, 2, 4, 4, and 1, respectively. RADAI scores were correlated significantly with the physician global estimate, except in SLE, and at higher levels with the MDHAQ and RAPID3 scores in all diagnostic groups. The RADAI self-report joint counts can be used to record self-report involvement of specific joints and joint groups in patients with SLE, OA, PsA, and gout, with minimal effort on the part of the rheumatologist.

Repeated measures in rheumatoid arthritis reduced the required sample size in a two-armed clinical trial

Objectives To investigate whether repeated measures in patients with rheumatoid arthritis will reduce the between subject variation and if so, to determine the optimal number of measures to effectively reduce the number of participants required in controlled clinical trials. Study Design and Setting A prospective observational study. Thirty-eight rheumatoid arthritis patients with a stable disease reported level of joint pain, fatigue and patient global assessment of disease activity on VAS scales as well as the Rheumatoid Arthritis Disease Activity Index (RADAI) daily during a total of 42 days. Results In all measures, the variation within each individual was substantial over a 42-day period. By increasing the number of measurements from one to five, the standard deviation (SD) decreased from 5.5% (RADAI score) to 11% (Pain VAS) resulting in a reduction in the number of patients needed in a clinical trial from 11% to 22%, respectively. When we used from 6 to 42 individual measurements, the decrease continued but the reduction was of a smaller magnitude. Conclusion The use of up to five repeated measurements per patient will decrease the number of patients required in a two armed clinical trial by as much as 22%.

Psychometric properties of the Rheumatoid Arthritis Disease Activity Index (RADAI) in a cohort of consecutive Dutch patients with RA starting anti-tumour necrosis factor treatment

Objectives:To examine the psychometric properties of the self-administered Dutch Rheumatoid Arthritis Disease Activity Index (RADAI) and its short form (RADAI-SF) in patients with rheumatoid arthritis starting anti-tumour necrosis factor treatment.Method:Internal...

Responsiveness of the self-assessed rheumatoid arthritis disease activity index to a flare of disease activity.

To assess the responsiveness of the Rheumatoid Arthritis Disease Activity Index (RADAI) to increases in disease activity, using the occurrence of a flare of disease activity as an external standard. A post hoc analysis was performed on data from a randomized, double-blind, controlled trial of methotrexate versus type II collagen in 92 patients with rheumatoid arthritis (RA). Responsiveness was analyzed by 1) correlating change in the RADAI score with change in the Disease Activity Score (DAS28), 2) determining the RADAI's ability to detect a disease flare by plotting a receiver operating characteristic (ROC) curve, and 3) using a responsiveness statistic, the standardized effect size (SES). The contribution of the single RADAI items to the change in total RADAI score was analyzed by the item score change in absolute value, the item responsiveness by the standardized response mean, and the correlation of item score change with total RADAI score change by Cronbach's alpha. Changes in the RADAI score correlated strongly with changes in the DAS28 (R2 = 0.70, P < 0.0001). The area under the ROC curve for the RADAI was 0.88 (95% confidence interval 0.78-0.95), which was similar to that for the DAS28. The SES for the RADAI was 1.56, which was also similar to that for the DAS28. The RADAI items of past global disease activity and morning stiffness contributed least to the total score change. This study provides evidence that the RADAI is sensitive to relevant increases in disease activity in RA patients. The RADAI may complement clinical measures in clinical studies, or may be used as a proxy for disease activity in epidemiologic studies.