RESEARCH - Reevaluation of the role of duration of morning stiffness in the assessment of RA activity

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J Rheumatol. 2009 Oct 15. [Epub ahead of print]

Reevaluation of the Role of Duration of Morning Stiffness in the

Assessment of Rheumatoid Arthritis Activity

Khan NA, Yazici Y, Calvo-Alen J, Dadoniene J, Gossec L, Hansen TM,

Huisman M, Kallikorm R, Muller R, Liveborn M, Oding R, Luchikhina E,

Naranjo A, Rexhepi S, P, Tlustochowich W, Tsirogianni A, Sokka

T.

From the University of Arkansas for Medical Sciences and Central

Arkansas Veterans Healthcare System, Little Rock, Arkansas; NYU

Hospital for Joint Diseases, New York, New York, USA; Hospital

Sierrallana Ganzo, Torrelavega, Spain; Institute of Experimental and

Clinical Medicine at Vilnius University, Vilnius, Lithuania; Paris

Descartes University, Medicine Faculty, Paris; UPRES-EA 4058; APHP,

Rheumatology B Department, Cochin Hospital, Paris, France; Copenhagen

University Hospital at Herlev, Herlev, Denmark; Sint Franciscus

Gasthuis Hospital, Rotterdam, The Netherlands; Centrallasarettet,

Västerås, Sweden; Institute of Rheumatology, Russian Academy of

Medical Sciences, Moscow, Russia; Tartu University Hospital, Tartu,

Estonia; Hospital de Gran Canaria Dr . Negrin, Las Palmas, Spain;

Rheumatology Department, Pristine, Kosovo; Charing Cross Hospital,

London, UK; Military Institute of Medicine, Warsaw, Poland; School of

Medicine, National University of Athens, Athens, Greece; Jyväskylä

Central Hospital, Jyväskylä; and Medcare Oy, Aänekoski, Finland.

OBJECTIVE: To evaluate the utility of the duration of morning

stiffness (MS), as a patient-reported outcome (PRO), in assessing

rheumatoid arthritis (RA) disease activity.

METHODS: We acquired information on 5439 patients in QUEST-RA, an

international database of patients with RA evaluated by a standard

protocol. MS duration was assessed from time of waking to time of

maximal improvement. Ability of MS duration to differentiate RA

activity states, based on Disease Activity Score (DAS)28, was assessed

by analysis of variance; and a receiver-operating characteristic (ROC)

curve was plotted for discriminating clinically active (DAS28 > 3.2)

from less active (DAS28 </= 3.2) RA. Mixed-effect analysis of

covariance (ANCOVA) models were used to assess the utility of adding

MS duration to Routine Assessment of Patient Index Data (RAPID) 3, a

PRO index based on physical function, pain, and general health (GH),

in predicting the 3-variable DAS28 (DAS28v3).

RESULTS: MS duration had moderate correlation (r = 0.41-0.48) with

pain, Health Assessment Questionnaire, and GH; and weak correlation (r

= 0.23-0.39) with joint counts and erythrocyte sedimentation rate. MS

duration differed significantly among patients with different RA

activity (p < 0.001). The area under the ROC curve of 0.74 (95% CI

0.72-0.75) showed moderate ability of MS duration to differentiate

clinically active from less active RA. ANCOVA showed significant

interactive effects between RAPID3 and the MS duration categories (p =

0.0005) in predicting DAS28v3. The effect of MS was found to be

clinically important in patients with the low RAPID3 scores (< 6) in

whom the presence of MS may indicate clinically active disease

(DAS28v3 > 3.2).

CONCLUSION: MS duration has a moderate correlation with RA disease

activity. Assessment of MS duration may be clinically helpful in

patients with low RAPID3 scores.

PMID: 19833759

http://www.ncbi.nlm.nih.gov/pubmed/19833759

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