The comparative responsiveness of the patient self-report questionnaires and composite disease indices for assessing rheumatoid arthritis activity in routine care

• Published in: Clinical and experimental rheumatology 2012-11, Vol.30 (6), p.912-921
• Main Authors: SALAFFI, F, CIAPETTI, A, GASPARINI, S, CAROTTI, M, BOMBARDIERI, S
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antirheumatic Agents - therapeutic use; Area Under Curve; Arthralgia - diagnosis; Arthralgia - drug therapy; Arthralgia - etiology; Arthralgia - physiopathology; Arthritis, Rheumatoid - blood; Arthritis, Rheumatoid - complications; Arthritis, Rheumatoid - diagnosis; Arthritis, Rheumatoid - drug therapy; Arthritis, Rheumatoid - physiopathology; Biological and medical sciences; Biological Products - therapeutic use; Biomarkers - blood; Blood Sedimentation; C-Reactive Protein - analysis; Decision Support Techniques; Diseases of the osteoarticular system; Female; Health Status Indicators; Humans; Inflammatory joint diseases; Italy; Joints - drug effects; Joints - physiopathology; Male; Medical sciences; Middle Aged; Pain Measurement; Predictive Value of Tests; Prospective Studies; ROC Curve; Self Report; Severity of Illness Index; Treatment Outcome
• ISSN: 0392-856X; 1593-098X

This paper aims to evaluate the internal and external responsiveness of the patient self-report questionnaires, comparatively to the traditional composite indices to assess the activity of rheumatoid arthritis (RA) in everyday practice. One hundred and ninety-one RA out-patients completed the clinical arthritis activity (PRO-CLARA) index, the rheumatoid arthritis disease activity index (RADAI), the routine assessment of patient index data (RAPID3), and the patient activity score (PAS). Simultaneously, the disease activity score-28 joints based on CRP (DAS28-CRP) and ESR (DAS28-ESR), the simplified disease activity index (SDAI), the clinical disease activity index (CDAI), and the mean overall index for RA (MOI-RA) were computed for each patient. Sensitivity to change was assessed after 6 months of treatment with disease-modifying anti-rheumatic drugs or biologics. Internal responsiveness was evaluated with the effect size (ES) and standardised response mean (SRM). External responsiveness was investigated by receiver operating characteristic (ROC), in categories of respondents, stratified according to the response on an item on change in overall health. In addition, change scores were compared by calculating correlation coefficients. No significant differences in internal and external responsiveness were found between self-report questionnaires and composite indices. The internal responsiveness of the self-report questionnaires and composite measures was wide, with SRM and ES ranging from 1.03 (RADAI) to 1.80 (DAS28-ESR) and higher than that of the each individual measures. The responsiveness of the PRO-CLARA was equal to the DAS28-ESR, DAS28-CRP, SDAI or MOI-RA, but better than the CDAI. The RADAI and PAS were less responsive than the PRO-CLARA and RAPID3. The area under ROC curve of the PRO-CLARA gives identical results to those provided by other comparator composite indices. The score changes of all combinations were highly correlated (p