RADAI-5 to monitor rheumatoid arthritis.

Providing the physician with sufficient information about the disease course can be regarded as the most important requirement for any disease assessment tool besides easy applicability and time-sparing documentation. Applying the RADAI-5 in daily routine provides the patient's view at any time completing the questionnaire. In a first study, the RADAI-5 resulted to be highly significantly correlated to the RADAI, and all composite indexes. Changes of the RADAI-5, the DAS28-ESR, and the CDAI were significantly correlated, indicating the instrument's sensitivity to change. A second study including 392 RA patients led to the establishment of thresholds for disease activity categories according to the RADAI-5, as follows: 0.0 up to 1.4 for a remission-like state, 1.6 up to 3.0 for mild disease activity, 3.2 up to 5.4 for moderate and from 5.6 up to 10.0 for high disease activity. In a third study, remission according to the RADAI-5 appeared to be highly specific for the ACR/EULAR criteria for remission The RADAI-5 questionnaire constitutes an easily applicable tool for routine RA monitoring, providing physicians with reliable information about the disease course and sensitivity enough to sound the alarm should complications occur.

Comparison of three rheumatoid arthritis disease activity scores in clinical routine.

OBJECTIVE: To evaluate whether the revised disease activity cut-off values for the Simplified Disease Activity Index (SDAI) and the Clinical Disease Activity Index (CDAI) are in congruence with the Disease Activity Score including a 28-joint count (DAS28) disease activity criteria in daily clinical routine. PATIENTS AND METHODS: A total of 570 rheumatoid arthritis (RA) outpatients were assessed and categorized according to the DAS28, the SDAI, and the CDAI. These results were compared to the respective DAS28 disease activity categories. Statistical evaluation was carried out by calculating alpha, the Spearman rank correlation, and kappa-statistics. RESULTS: DAS28, SDAI, and CDAI levels were significantly correlated to one another on a group level (p < 0.001). Internal consistency was the highest for the CDAI (alpha = 0.783) and the lowest for the DAS28 (alpha = 0.664). Kappa-statistics revealed a substantial degree of agreement with respect to mild, moderate, and high disease activity according to the three scores, with exceptions concerning the definition of a remission-like state. Further categorization showed that an additional 44% of patients were found to be in remission according to the DAS28 disease activity criteria relative to those defined by the SDAI or the CDAI disease activity categories respectively. CONCLUSION: The revised SDAI limits for disease activity and the respective CDAI thresholds proved to be in congruence with the DAS28 disease activity categories in daily clinical routine. The SDAI and the CDAI were found to be more stringent in defining remission.

A tool for the assessment of hand involvement in rheumatic disorders in daily routine--the SF-SACRAH (short form score for the assessment and quantification of chronic rheumatic affections of the hands).

OBJECTIVE: To establish a questionnaire for quantification of hand involvement in osteoarthritis (OA) of the hands and rheumatoid arthritis (RA) meeting daily routine requirements. PATIENTS AND METHODS: The smallest number of questions of the modified score for the assessment and quantification of chronic rheumatic affections of the hands (M-SACRAH) providing reasonable reliability was identified by factor analysis and calculating Cronbach's alpha, subsequently resulting in a five-item scale, the short form-SACRAH (SF-SACRAH), which was then administered to 176 RA and 71 hand-OA (HOA) patients simultaneously with the M-SACRAH. Additionally, patient's satisfaction (PatSAT) with disease status was assessed (according to the Austrian school marking system from 1 to 5). Gamma was calculated to assess the agreement of the SF-SACRAH with the M-SACRAH and between the single corresponding questions of different formats. The Wilcoxon rank test was applied to estimate the relationship between PatSAT and the SF-SACRAH. RESULTS: Alpha for the SF-SACRAH in 176 RA and 71 HOA patients amounted to 0.869 and to 0.897, respectively, indicating high internal consistency. In both patient groups the SF-SACRAH was found to be significantly correlated to the M-SACRAH (both P(s)<0.01). Agreement between the corresponding questions of both scales was significant in both patient groups by calculating gamma (average gamma 0.683 in HOA and 0.847 in RA). PatSAT and SF-SACRAH values were highly significantly correlated (P<0.001) proving the score's external validity. CONCLUSION: The SF-SACRAH proved to be a brief and practicable tool to assess hand involvement in OA and RA meeting the requirements of daily routine.

SDAI/CDAI levels in rheumatoid arthritis patients are highly dependent on patient's pain perception and gender.

OBJECTIVE: To determine whether the Simplified Disease Activity Index (SDAI) and the Clinical Disease Activity Index (CDAI) are equally applicable for the total population with rheumatoid arthritis (RA). METHODS: Five hundred and fifty-seven outpatients with RA [432 females, 125 males; median age 64 years (range 18-85); median disease duration 48 months (range 2-548)] were enrolled consecutively in this cross-sectional study. SDAI, CDAI, patient's assessment of pain on the visual analogue scale (VAS) 0-100, rheumatoid factor (RF), and disease duration were recorded. Linear regression analysis was performed for each confounding factor. RESULTS: The median SDAI for all 557 patients was 11.6 (range 0.07-46.60) and the median CDAI was 10.7 (0.00-42.10). The median SDAI was 12.2 (0.07-46.60) in females and 8.0 (0.10-35.20) in males. The respective medians for the CDAI were 11.3 (0.00-42.10) and 7.1 (0.00-32.00). These differences were highly statistically significant (p<0.001). Patient's assessment of pain on the VAS 0-100 scale had a median value of 32 mm. Regression analysis revealed a highly significant relationship between SDAI/CDAI levels and patient's pain rating (SDAI: r = 0.660, p<0.001; CDAI: r = 0.671, p<0.001). On multiple regression analysis, pain exerted a highly significant influence on SDAI and CDAI levels (p<0.001), whereas age, disease duration, and RF were not correlated with either level. CONCLUSION: SDAI and CDAI values are highly dependent on the patient's pain perception and gender. The effects of patient's age, disease duration, and RF were inconclusive with respect to the values of the respective disease activity indexes.