RT Journal Article
SR Electronic
T1 Reevaluation of the Role of Duration of Morning Stiffness in the Assessment of Rheumatoid Arthritis Activity
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP 2435
OP 2442
DO 10.3899/jrheum.081175
VO 36
IS 11
A1 NASIM A. KHAN
A1 YUSUF YAZICI
A1 JAIME CALVO-ALEN
A1 JOLANTA DADONIENE
A1 LAURE GOSSEC
A1 TROELS M. HANSEN
A1 MARGRIET HUISMAN
A1 RIINA KALLIKORM
A1 RAILI MULLER
A1 MARGARETH LIVEBORN
A1 ROLF ODING
A1 ELENA LUCHIKHINA
A1 ANTONIO NARANJO
A1 SYLEJMAN REXHEPI
A1 PETER TAYLOR
A1 WITOLD TLUSTOCHOWICH
A1 AFRODITE TSIROGIANNI
A1 TUULIKKI SOKKA
YR 2009
UL http://www.jrheum.org/content/36/11/2435.abstract
AB 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.