Further optimization of the reliability of the 28-joint disease activity score in patients with early rheumatoid arthritis.

<h4>Background</h4>The 28-joint Disease Activity Score (DAS28) combines scores on a 28-tender and swollen joint count (TJC28 and SJC28), a patient-reported measure for general health (GH), and an inflammatory marker (either the erythrocyte sedimentation rate [ESR] or the C-reactive prote...

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Autores principales:	Liseth Siemons, Peter M ten Klooster, Harald E Vonkeman, Mart A F J van de Laar, Cees A W Glas
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2014
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/7251dfcb084e488abc423f9320c3e3a2
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spelling	oai:doaj.org-article:7251dfcb084e488abc423f9320c3e3a22021-11-18T08:14:44ZFurther optimization of the reliability of the 28-joint disease activity score in patients with early rheumatoid arthritis.1932-620310.1371/journal.pone.0100544https://doaj.org/article/7251dfcb084e488abc423f9320c3e3a22014-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24955759/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>The 28-joint Disease Activity Score (DAS28) combines scores on a 28-tender and swollen joint count (TJC28 and SJC28), a patient-reported measure for general health (GH), and an inflammatory marker (either the erythrocyte sedimentation rate [ESR] or the C-reactive protein [CRP]) into a composite measure of disease activity in rheumatoid arthritis (RA). This study examined the reliability of the DAS28 in patients with early RA using principles from generalizability theory and evaluated whether it could be increased by adjusting individual DAS28 component weights.<h4>Methods</h4>Patients were drawn from the DREAM registry and classified into a "fast response" group (N = 466) and "slow response" group (N = 80), depending on their pace of reaching remission. Composite reliabilities of the DAS28-ESR and DAS28-CRP were determined with the individual components' reliability, weights, variances, error variances, correlations and covariances. Weight optimization was performed by minimizing the error variance of the index.<h4>Results</h4>Composite reliabilities of 0.85 and 0.86 were found for the DAS28-ESR and DAS28-CRP, respectively, and were approximately equal across patients groups. Component reliabilities, however, varied widely both within and between sub-groups, ranging from 0.614 for GH ("slow response" group) to 0.912 for ESR ("fast response" group). Weight optimization increased composite reliability even further. In the total and "fast response" groups, this was achieved mostly by decreasing the weight of the TJC28 and GH. In the "slow response" group, though, the weights of the TJC28 and SJC28 were increased, while those of the inflammatory markers and GH were substantially decreased.<h4>Conclusions</h4>The DAS28-ESR and the DAS28-CRP are reliable instruments for assessing disease activity in early RA and reliability can be increased even further by adjusting component weights. Given the low reliability and weightings of the general health component across subgroups it is recommended to explore alternative patient-reported outcome measures for inclusion in the DAS28.Liseth SiemonsPeter M ten KloosterHarald E VonkemanMart A F J van de LaarCees A W GlasPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 6, p e100544 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Liseth Siemons Peter M ten Klooster Harald E Vonkeman Mart A F J van de Laar Cees A W Glas Further optimization of the reliability of the 28-joint disease activity score in patients with early rheumatoid arthritis.
description	<h4>Background</h4>The 28-joint Disease Activity Score (DAS28) combines scores on a 28-tender and swollen joint count (TJC28 and SJC28), a patient-reported measure for general health (GH), and an inflammatory marker (either the erythrocyte sedimentation rate [ESR] or the C-reactive protein [CRP]) into a composite measure of disease activity in rheumatoid arthritis (RA). This study examined the reliability of the DAS28 in patients with early RA using principles from generalizability theory and evaluated whether it could be increased by adjusting individual DAS28 component weights.<h4>Methods</h4>Patients were drawn from the DREAM registry and classified into a "fast response" group (N = 466) and "slow response" group (N = 80), depending on their pace of reaching remission. Composite reliabilities of the DAS28-ESR and DAS28-CRP were determined with the individual components' reliability, weights, variances, error variances, correlations and covariances. Weight optimization was performed by minimizing the error variance of the index.<h4>Results</h4>Composite reliabilities of 0.85 and 0.86 were found for the DAS28-ESR and DAS28-CRP, respectively, and were approximately equal across patients groups. Component reliabilities, however, varied widely both within and between sub-groups, ranging from 0.614 for GH ("slow response" group) to 0.912 for ESR ("fast response" group). Weight optimization increased composite reliability even further. In the total and "fast response" groups, this was achieved mostly by decreasing the weight of the TJC28 and GH. In the "slow response" group, though, the weights of the TJC28 and SJC28 were increased, while those of the inflammatory markers and GH were substantially decreased.<h4>Conclusions</h4>The DAS28-ESR and the DAS28-CRP are reliable instruments for assessing disease activity in early RA and reliability can be increased even further by adjusting component weights. Given the low reliability and weightings of the general health component across subgroups it is recommended to explore alternative patient-reported outcome measures for inclusion in the DAS28.
format	article
author	Liseth Siemons Peter M ten Klooster Harald E Vonkeman Mart A F J van de Laar Cees A W Glas
author_facet	Liseth Siemons Peter M ten Klooster Harald E Vonkeman Mart A F J van de Laar Cees A W Glas
author_sort	Liseth Siemons
title	Further optimization of the reliability of the 28-joint disease activity score in patients with early rheumatoid arthritis.
title_short	Further optimization of the reliability of the 28-joint disease activity score in patients with early rheumatoid arthritis.
title_full	Further optimization of the reliability of the 28-joint disease activity score in patients with early rheumatoid arthritis.
title_fullStr	Further optimization of the reliability of the 28-joint disease activity score in patients with early rheumatoid arthritis.
title_full_unstemmed	Further optimization of the reliability of the 28-joint disease activity score in patients with early rheumatoid arthritis.
title_sort	further optimization of the reliability of the 28-joint disease activity score in patients with early rheumatoid arthritis.
publisher	Public Library of Science (PLoS)
publishDate	2014
url	https://doaj.org/article/7251dfcb084e488abc423f9320c3e3a2
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Further optimization of the reliability of the 28-joint disease activity score in patients with early rheumatoid arthritis.

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