类风湿关节炎活动期临床判断.pptVIP

* * * * * * * * * * * * * * * * ?2004 Rho, Inc. All rights reserved. No part of this document may be copied without express written consent. 类风湿关节炎活动度临床判断 Clinical Assessment of Rheumatoid Arthritis Disease Activity (Partly quoted from Jonathan Kay, MD) Content Why quantify RA disease activity? Composite disease activity indices Response criteria for clinical trials Patient-reported outcome measures Quantitatively-driven therapy for early RA Data collection tools Shaw on Measurement “The only man who behaved sensibly was my tailor; he took my measure anew every time he saw me, whilst all the rest went on with their old measurements and expected them to fit me.” -George Bernard Shaw (1856-1950) How to quantify RA disease activity Clinical composite indices -DAS / DAS28 -SDAS -CDAI Patient-reported outcome measures Imaging - Plain radiographs - Musculoskeletal ultrasound - MRI Primary site of RA disease activity Persistent synovitis results in -Joint destruction -Disability Goal of treatment (remission) is absence of synovitis Tender swollen joint counts are outcome upon which therapeutic decisions are based Why Assess Joints? Reported as %improvement, comparing disease activity at two discrete time points -ACR20 is ≥ 20% improvement -ACR50 is ≥ 50% improvement (ACR50 responders include ACR20 responders) -ACR70 is ≥ 70% improvement (ACR70 responders include ACR20 and ACR50 responders) Used to maximally discriminate effective treatment from placebo treatment in clinical trials Not directly applicable to clinical practice DT Felson et al. Arthritis Rheum.1995;38(6):727-735 ACR response criteria:the traditional dichotomous benchmark Disease Activity Score (DAS) DAS28 Simplified Disease Activity Index(SDAI)（简化的DAS评分） Clinical Disease Activity Index(CDAI)（临床DAS评分） Continuous Measures of RA Disease Activity DAS=0.54?(Tender 44)1/2 +0.06 ?(Swollen 66)1/2 + 0.33 In(ESR)+ 0.007 (Global Health on VAS) （4