PMID- 25988705
OWN - NLM
STAT- MEDLINE
DCOM- 20151215
LR  - 20220317
IS  - 2151-4658 (Electronic)
IS  - 2151-464X (Print)
IS  - 2151-464X (Linking)
VI  - 67
IP  - 10
DP  - 2015 Oct
TI  - Determining the Minimally Important Difference in the Clinical Disease Activity 
      Index for Improvement and Worsening in Early Rheumatoid Arthritis Patients.
PG  - 1345-53
LID - 10.1002/acr.22606 [doi]
AB  - OBJECTIVE: Simplified measures to quantify rheumatoid arthritis (RA) disease 
      activity are increasingly used. The minimum clinically important differences 
      (MCID) for some measures, such as the Clinical Disease Activity Index (CDAI), 
      have not been well-defined in real-world clinic settings, especially for early RA 
      patients with low/moderate disease activity. METHODS: Data from Canadian Early 
      Arthritis Cohort patients were used to examine absolute change in CDAI in the 
      first year after enrollment, stratified by disease activity. MCID cut points were 
      derived to optimize the sum of sensitivity and specificity versus the gold 
      standard of patient self-reported improvement or worsening. Sensitivity, 
      specificity, positive predictive values, and negative predictive values were 
      calculated against patient self-reported improvement (gold standard) and for 
      change in pain, Health Assessment Questionnaire (HAQ), and Disease Activity Score 
      in 28 joints (DAS28) improvement. Discrimination was examined using the area 
      under receiver operator curves. Similar methods were used to evaluate MCIDs for 
      worsening for patients who achieved low disease activity. RESULTS: A total of 578 
      patients (mean +/- SD age 54.1 +/- 15.3 years, 75% women, median [interquartile 
      range] disease duration 5.3 [3.3, 8.0] months) contributed 1,169 visit pairs to 
      the improvement analysis. The MCID cut points for improvement were 12 (patients 
      starting in high disease activity: CDAI >22), 6 (moderate: CDAI 10-22), and 1 
      (low disease activity: CDAI <10). Performance characteristics were acceptable 
      using these cut points for pain, HAQ, and DAS28. The MCID for CDAI worsening 
      among patients who achieved low disease activity was 2 units. CONCLUSION: These 
      minimum important absolute differences in CDAI can be used to evaluate 
      improvement and worsening and increase the utility of CDAI in clinical practice.
CI  - (c) 2015, American College of Rheumatology.
FAU - Curtis, J R
AU  - Curtis JR
AD  - University of Alabama at Birmingham.
FAU - Yang, S
AU  - Yang S
AD  - University of Alabama at Birmingham.
FAU - Chen, L
AU  - Chen L
AD  - University of Alabama at Birmingham.
FAU - Pope, J E
AU  - Pope JE
AD  - St. Joseph's Health Center and Western University, London, Ontario, Canada.
FAU - Keystone, E C
AU  - Keystone EC
AD  - Mount Sinai Hospital/University of Toronto, Toronto, Ontario, Canada.
FAU - Haraoui, B
AU  - Haraoui B
AD  - Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada.
FAU - Boire, G
AU  - Boire G
AD  - Centre Hospitalier Universitaire de Sherbrooke and Universite de Sherbrooke, 
      Sherbrooke, Quebec, Canada.
FAU - Thorne, J C
AU  - Thorne JC
AD  - Southlake Regional Health Centre, Newmarket, Ontario, Canada.
FAU - Tin, D
AU  - Tin D
AD  - Southlake Regional Health Centre, Newmarket, Ontario, Canada.
FAU - Hitchon, C A
AU  - Hitchon CA
AD  - University of Manitoba, Winnipeg, Manitoba, Canada.
FAU - Bingham, C O 3rd
AU  - Bingham CO 3rd
AD  - Johns Hopkins University, Baltimore, Maryland.
FAU - Bykerk, V P
AU  - Bykerk VP
AD  - Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada, and 
      Hospital for Special Surgery, New York, New York.
LA  - eng
GR  - HS-018517/HS/AHRQ HHS/United States
GR  - K23 AR053351/AR/NIAMS NIH HHS/United States
GR  - P60 AR064172/AR/NIAMS NIH HHS/United States
GR  - R01 HS018517/HS/AHRQ HHS/United States
GR  - AR-064172/AR/NIAMS NIH HHS/United States
GR  - UH2 AR067691/AR/NIAMS NIH HHS/United States
GR  - 1UH2-AR-067691-01/AR/NIAMS NIH HHS/United States
PT  - Evaluation Study
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
PT  - Research Support, U.S. Gov't, P.H.S.
PL  - United States
TA  - Arthritis Care Res (Hoboken)
JT  - Arthritis care & research
JID - 101518086
RN  - 0 (Antirheumatic Agents)
SB  - IM
MH  - Adult
MH  - Age Factors
MH  - Aged
MH  - Antirheumatic Agents/*therapeutic use
MH  - Arthritis, Rheumatoid/*drug therapy/epidemiology/*physiopathology
MH  - Canada
MH  - Cohort Studies
MH  - Databases, Factual
MH  - Disability Evaluation
MH  - *Disease Progression
MH  - Early Diagnosis
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Pain Measurement
MH  - Physical Examination/methods
MH  - Prognosis
MH  - ROC Curve
MH  - Range of Motion, Articular/*physiology
MH  - Reproducibility of Results
MH  - Retrospective Studies
MH  - Self Report
MH  - Sensitivity and Specificity
MH  - Severity of Illness Index
MH  - Sex Factors
MH  - Sickness Impact Profile
MH  - Treatment Outcome
PMC - PMC4580563
MID - NIHMS685338
EDAT- 2015/05/20 06:00
MHDA- 2015/12/17 06:00
PMCR- 2016/10/01
CRDT- 2015/05/20 06:00
PHST- 2014/07/21 00:00 [received]
PHST- 2015/03/18 00:00 [revised]
PHST- 2015/04/21 00:00 [accepted]
PHST- 2015/05/20 06:00 [entrez]
PHST- 2015/05/20 06:00 [pubmed]
PHST- 2015/12/17 06:00 [medline]
PHST- 2016/10/01 00:00 [pmc-release]
AID - 10.1002/acr.22606 [doi]
PST - ppublish
SO  - Arthritis Care Res (Hoboken). 2015 Oct;67(10):1345-53. doi: 10.1002/acr.22606.