Publish in this journal
Journal Information
Vol. 15. Issue 3.
Pages 146-151 (May - June 2019)
Share
Share
Download PDF
More article options
ePub
Visits
7
Vol. 15. Issue 3.
Pages 146-151 (May - June 2019)
Original Article
DOI: 10.1016/j.reumae.2018.10.008
Severity Indices in Rheumatoid Arthritis: A Systematic Review
Índices de gravedad en la artritis reumatoide: una revisión sistemática
Visits
7
Esther Toledanoa,
Corresponding author
esthertoledano@hotmail.com

Corresponding author.
, M. Jesús García de Yébenesb, Isidoro González-Álvaroc,1, Loreto Carmonab,1
a Servicio de Reumatología, Hospital Clínico San Carlos, Madrid, Spain
b InMusc, Madrid, Spain
c Servicio de Reumatología. Hospital Universitario La Princesa, Madrid, Spain
This item has received
7
Visits
Article information
Abstract
Full Text
Bibliography
Download PDF
Statistics
Figures (1)
Tables (1)
Table 1. Characteristics of the Indices Included in the Review.
Additional material (1)
Abstract
Objective

To identify tools designed to evaluate the severity of patients with rheumatoid arthritis (RA) in order to use them in the investigation of prognostic markers in early arthritis.

Methods

We conducted a systematic review of studies that developed/validated an index for RA disease severity. They were analysed using the COSMIN checklist to assess their methodological quality. In addition, all the variables included were evaluated for their clarity of definition, feasibility and probability of being present in each outcome during the first 2 years of the disease course. To estimate redundancy, variables were grouped by domains.

Results

After reviewing 3519 articles, 3 studies were included. The first study, the PAS, assessed whether current and lifetime treatment with disease-modifying antirheumatic drugs and/or biologics accurately predicted RA severity, as measured by the patient-reported PAS. Treatment variables did not fully distinguish patients in the highest and lowest quartiles of PAS scores. Another severity index, the Claims-Based Index for RA Severity (CIRAS), included the variables age, sex, Felty's syndrome, number of rehabilitation and rheumatology visits, test for inflammatory markers, number of chemistry panels/platelet counts ordered and rheumatoid factor test. The correlation was low (r=0.56) with an index previously validated by the same research group, the RA medical records-based index of severity (RARBIS), with Disease Activity Score-C-reactive protein (DAS28-PCR) (r=0.07) and Multidimensional Health Assessment Questionnaire (MD-HAQ) (r=0.008). Finally, the RARBIS, used to validate the CIRAS, was devised as an RA severity index based on medical records. It includes as domains surgery, radiology, extra-articular manifestations, clinical and laboratory variables, previously chosen by an expert panel. RARBIS had a weak correlation with treatment intensity (r=0.35) and with DAS28 (r=0.41).

Conclusion

There is no index to assess the severity of RA based on the course of the first 2 years of follow-up that is adapted to the current strategy of therapeutic management of this disease. Therefore, we believe it is reasonable to develop a new ad hoc severity index for patients with early arthritis.

Keywords:
Rheumatoid arthritis
Early arthritis
Index or questionnaire
Severity
Systematic review
Resumen
Objetivo

Identificar herramientas diseñadas para evaluar la gravedad global de los pacientes con artritis reumatoide (AR) para su uso en la investigación de marcadores pronósticos de artritis precoz.

Métodos

Revisión sistemática de estudios cuyo objetivo fuera el desarrollo o validación de índices de gravedad en AR. Se valoró la calidad metodológica mediante la lista de comprobación COSMIN. Además, se evaluó la claridad de definición, viabilidad y probabilidad de estar presente durante los 2 primeros años de evolución.

Resultados

Después de revisar 3.519 artículos, se identificaron 3 índices de gravedad. La Patient Activity Scale (PAS) valoró si el tratamiento previo o actual predecía la gravedad de la AR, medida mediante el patient-reported PAS. Las variables de tratamiento no permitieron distinguir entre los cuartiles superior e inferior de la PAS. El CIRAS incluye las variables edad, sexo, síndrome de Felty, número de visitas al reumatólogo y al rehabilitador, factor reumatoide (FR), recuento de plaquetas, marcadores inflamatorios y paneles bioquímicos solicitados. Su correlación fue baja (r=0,56), con un índice previamente validado por el mismo grupo investigador, el RARBIS, con el DAS28-PCR (r=0,07) y el Multidimensional Health Assesment Questionnaire (MD-HAQ) (r=0,008). Por último, el RARBIS, utilizado para validar el CIRAS, fue ideado como un índice de gravedad de AR basado en registros médicos. Incluye como dominios cirugía, radiología, manifestaciones extraarticulares, clínica y variables de laboratorio, elegidas previamente por un panel de expertos. Este índice presentó una correlación débil con la intensidad de tratamiento (r=0,35) y con el DAS 28 (r=0,41).

Conclusión

No existe ningún índice para valorar la gravedad de la AR sobre la base del curso evolutivo de los 2 primeros años de seguimiento y que se adapte a la estrategia terapéutica actual. Por lo tanto, creemos razonable el desarrollo de un nuevo índice de gravedad ad hoc para pacientes con artritis de reciente comienzo.

Palabras clave:
Artritis reumatoide
Artritis de inicio
Índices o cuestionarios
Gravedad
Revisión sistemática

Article

These are the options to access the full texts of the publication Reumatología Clínica (English Edition)
Member
If you are member of Sociedad Española de Reumatología (SER) or the Colegio Mexicano de Reumatología (CMR):
Please go to the member area of SER or CMR and log in.
Subscriber
Subscriber

If you already have your login data, please click here .

If you have forgotten your password you can you can recover it by clicking here and selecting the option “I have forgotten my password”
Subscribe
Subscribe to

Reumatología Clínica (English Edition)

Contact
Phone for subscriptions and reporting of errors
From Monday to Friday from 9 a.m. to 6 p.m. (GMT + 1) except for the months of July and August which will be from 9 a.m. to 3 p.m.
Calls from Spain
932 415 960
Calls from outside Spain
+34 932 415 960
Email
Idiomas
Reumatología Clínica (English Edition)

Subscribe to our newsletter

Article options
Tools
Supplemental materials
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

es en
Política de cookies Cookies policy
Utilizamos cookies propias y de terceros para mejorar nuestros servicios y mostrarle publicidad relacionada con sus preferencias mediante el análisis de sus hábitos de navegación. Si continua navegando, consideramos que acepta su uso. Puede cambiar la configuración u obtener más información aquí. To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.