PMID- 20542894
OWN - NLM
STAT- MEDLINE
DCOM- 20110506
LR  - 20211028
IS  - 1462-0332 (Electronic)
IS  - 1462-0324 (Linking)
VI  - 49
IP  - 10
DP  - 2010 Oct
TI  - Persistently moderate DAS-28 is not benign: loss of function occurs in early RA 
      despite step-up DMARD therapy.
PG  - 1894-9
LID - 10.1093/rheumatology/keq178 [doi]
AB  - OBJECTIVES: Current UK management of RA initially employs conventional DMARDs, 
      with biological therapy reserved for DMARD-resistant RA patients with 
      persistently high 28-joint disease activity score (DAS-28). The aim of this study 
      was to examine the effect on patient-reported function of persistently moderate 
      DAS-28 despite modern step-up DMARD therapy in an early arthritis cohort. 
      METHODS: Data were obtained from the Yorkshire Early Arthritis Register, a cohort 
      of early (<12 months) RA patients treated with dose-escalated DMARDs. Change in 
      HAQ exceeding the minimum clinically important difference (MCID) was determined 
      for three values of MCID (0.22, 0.31 and 0.49). Changes in HAQ over Months 6-12 
      were compared between patients whose DAS-28(ESR) was persistently high (> 5.1 at 
      6- and/or 9-month visits and at the 12-month visit), persistently moderate (>3.2 
      and </= 5.1) or persistently low (</= 3.2). RESULTS: We selected 194 patients for 
      this analysis. Deteriorating HAQ scores were observed in 10.9% of patients with 
      persistently low DAS-28 compared with 21.4% (persistently moderate DAS-28) and 
      46.7% (persistently high DAS-28), respectively, for MCID = 0.22; 7.3, 14.3 and 
      20.0% for MCID = 0.31; 5.5, 10.7 and 11.1% for MCID = 0.49. CONCLUSIONS: A high 
      DAS-28 was generally associated with a greater degree of functional decline, but 
      persistent moderate elevation of DAS-28 was associated with important functional 
      deterioration in 10-21% of early RA patients (depending on choice of MCID) 
      following a modern DMARD protocol. A proportion of patients with persistently 
      moderate DAS-28 may therefore benefit from more aggressive therapy than that 
      allowed by current UK recommendations.
FAU - Conaghan, Philip G
AU  - Conaghan PG
AD  - Section of Musculoskeletal Disease, Chapel Allerton Hospital, Leeds, UK. 
      p.conaghan@leeds.ac.uk
FAU - Hensor, Elizabeth M A
AU  - Hensor EM
FAU - Keenan, Anne-Maree
AU  - Keenan AM
FAU - Morgan, Ann W
AU  - Morgan AW
FAU - Emery, Paul
AU  - Emery P
CN  - YEAR Consortium
LA  - eng
GR  - 18475/ARC_/Arthritis Research UK/United Kingdom
GR  - 18475/VAC_/Versus Arthritis/United Kingdom
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20100611
PL  - England
TA  - Rheumatology (Oxford)
JT  - Rheumatology (Oxford, England)
JID - 100883501
RN  - 0 (Antirheumatic Agents)
RN  - 0 (Tumor Necrosis Factor-alpha)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Antirheumatic Agents/*therapeutic use
MH  - Arthritis, Rheumatoid/drug therapy/*physiopathology
MH  - Cohort Studies
MH  - *Disability Evaluation
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Severity of Illness Index
MH  - Treatment Outcome
MH  - Tumor Necrosis Factor-alpha/*antagonists & inhibitors/therapeutic use
FIR - Emery, Paul
IR  - Emery P
FIR - Conaghan, Philip
IR  - Conaghan P
FIR - Ann, Ann
IR  - Ann A
FIR - Keenan, Anne-Maree
IR  - Keenan AM
FIR - Hensor, Elizabeth
IR  - Hensor E
FIR - Quinn, Mark
IR  - Quinn M
FIR - Gough, Andrew
IR  - Gough A
FIR - Green, Michael
IR  - Green M
FIR - Reece, Richard
IR  - Reece R
FIR - Hordon, Lesley
IR  - Hordon L
FIR - Helliwell, Philip
IR  - Helliwell P
FIR - Melsom, Richard
IR  - Melsom R
FIR - Doherty, Sheelagh
IR  - Doherty S
FIR - Adebajo, Ade
IR  - Adebajo A
FIR - Harvey, Andrew
IR  - Harvey A
FIR - Jarrett, Steve
IR  - Jarrett S
FIR - Huson, Gareth
IR  - Huson G
FIR - Isdale, Amanda
IR  - Isdale A
FIR - Martin, Mike
IR  - Martin M
FIR - Karim, Zunaid
IR  - Karim Z
FIR - McGonagle, Dennis
IR  - McGonagle D
FIR - Pease, Colin
IR  - Pease C
FIR - Cox, Sally
IR  - Cox S
FIR - Bejarano, Victoria
IR  - Bejarano V
FIR - Nam, Jackie
IR  - Nam J
FIR - Villeneuve, Edith
IR  - Villeneuve E
FIR - Twigg, Sarah
IR  - Twigg S
FIR - Brown, Claire
IR  - Brown C
FIR - Thomas, Christine
IR  - Thomas C
FIR - Pickles, David
IR  - Pickles D
FIR - Hammond, Alison
IR  - Hammond A
FIR - Neville, Beverley
IR  - Neville B
FIR - Fairclough, Alan
IR  - Fairclough A
FIR - Nunns, Caroline
IR  - Nunns C
FIR - Gill, Anne
IR  - Gill A
FIR - Green, Julie
IR  - Green J
FIR - Rhys-Evans, Belinda
IR  - Rhys-Evans B
FIR - Padwell, Barbara
IR  - Padwell B
FIR - Madde, Julie
IR  - Madde J
FIR - Taylor, Lynda
IR  - Taylor L
FIR - Smith, Sally
IR  - Smith S
FIR - King, Heather
IR  - King H
FIR - Firth, Jill
IR  - Firth J
FIR - Heard, Jayne
IR  - Heard J
FIR - Sigsworth, Linda
IR  - Sigsworth L
FIR - Corscadden, Diane
IR  - Corscadden D
FIR - Henshaw, Karen
IR  - Henshaw K
FIR - Rashid, Lubna-Haroon
IR  - Rashid LH
FIR - Martin, Stephen G
IR  - Martin SG
FIR - Robinson, James I
IR  - Robinson JI
FIR - Kozera, Lukasz
IR  - Kozera L
FIR - Fahy, Sarah
IR  - Fahy S
FIR - Paterson, Andrea
IR  - Paterson A
EDAT- 2010/06/15 06:00
MHDA- 2011/05/07 06:00
CRDT- 2010/06/15 06:00
PHST- 2010/06/15 06:00 [entrez]
PHST- 2010/06/15 06:00 [pubmed]
PHST- 2011/05/07 06:00 [medline]
AID - keq178 [pii]
AID - 10.1093/rheumatology/keq178 [doi]
PST - ppublish
SO  - Rheumatology (Oxford). 2010 Oct;49(10):1894-9. doi: 10.1093/rheumatology/keq178. 
      Epub 2010 Jun 11.