Development and Validation of a New Disease Activity Index as a Numerical Sum of Four Variables in Patients With Early Arthritis

Castrejón, Isabel; Carmona, Loreto; Ortiz, Ana M.; Belmonte, Miguel Ángel Ortí; Martínez-López, Juan Antonio; González‐Álvaro, Isidoro

doi:10.1002/acr.21854

Cited by 12 publications

(30 citation statements)

References 33 publications

(37 reference statements)

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“…HUPI was developed and validated in a mixed population of early RA and undifferentiated arthritis (UA) patients, the Princesa Early Arthritis Register Longitudinal study (PEARL) cohort [6], which we now use also to define cut-offs. In order to determine whether HUPI and its cut-offs are valid in long-term RA we added the data from the Estudio de la Morbilidad y Expresión Clínica de la Artritis Reumatoide (EMECAR) cohort [12].…”

Section: Methodsmentioning

confidence: 99%

“…In relation to this strategy, there is substantial agreement on considering remission, or low disease activity, as the therapeutic objective for most patients with RA [1,2]. However, DAS28 and SDAI, the most widely-used indices for defining these targets, have several biases that may interfere with their accuracy [3–6]. DAS28 has the additional inconvenient that its values differ when it is calculated with either erytrosedimentation rate (ESR) or C-reactive protein (CRP) [7,8].…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, both DAS28 and SDAI have a gender bias derived from the larger number of tender joints and of ESR values in women compared to men [5,9,10]. To overcome these issues, we developed the Hospital Universitario La Princesa Index (HUPI), an index for the assessment of disease activity in chronic polyarthritis that includes the same domains as in DAS28 and SDAI but corrected by gender and easier to calculate than the DAS28 (Table 1) [6]. Moreover, it can be calculated with either CRP, or ESR or both.…”

Section: Introductionmentioning

confidence: 99%

“…This may be of special interest in observational studies to avoid missing data. HUPI has demonstrated high accuracy, feasibility and sensitivity to change, even superior to those of DAS28 and SDAI [6]. However, to be useful both in daily clinical practice and clinical trials it is necessary to define cut-off points that allow establishing different levels of disease activity, as well as response criteria, such as those based on DAS28 [11].…”

Section: Introductionmentioning

confidence: 99%

“…HUPI is calculated as the sum of four variables (graded 0–3): 28 tender and swollen joint counts, global disease assessment by physician and acute phase reactants (the average score value of ESR and CRP must be used if both acute phase reactants are considered). The score of these variables was based in their quartile distribution in the population used to describe the index [6]. …”

Section: Introductionmentioning

confidence: 99%

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Cut-Offs and Response Criteria for the Hospital Universitario La Princesa Index (HUPI) and Their Comparison to Widely-Used Indices of Disease Activity in Rheumatoid Arthritis

et al. 2016

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ObjectiveTo estimate cut-off points and to establish response criteria for the Hospital Universitario La Princesa Index (HUPI) in patients with chronic polyarthritis.MethodsTwo cohorts, one of early arthritis (Princesa Early Arthritis Register Longitudinal [PEARL] study) and other of long-term rheumatoid arthritis (Estudio de la Morbilidad y Expresión Clínica de la Artritis Reumatoide [EMECAR]) including altogether 1200 patients were used to determine cut-off values for remission, and for low, moderate and high activity through receiver operating curve (ROC) analysis. The areas under ROC (AUC) were compared to those of validated indexes (SDAI, CDAI, DAS28). ROC analysis was also applied to establish minimal and relevant clinical improvement for HUPI.ResultsThe best cut-off points for HUPI are 2, 5 and 9, classifying RA activity as remission if ≤2, low disease activity if >2 and ≤5), moderate if >5 and <9 and high if ≥9. HUPI’s AUC to discriminate between low-moderate activity was 0.909 and between moderate-high activity 0.887. DAS28’s AUCs were 0.887 and 0.846, respectively; both indices had higher accuracy than SDAI (AUCs: 0.832 and 0.756) and CDAI (AUCs: 0.789 and 0.728). HUPI discriminates remission better than DAS28-ESR in early arthritis, but similarly to SDAI. The HUPI cut-off for minimal clinical improvement was established at 2 and for relevant clinical improvement at 4. Response criteria were established based on these cut-off values.ConclusionsThe cut-offs proposed for HUPI perform adequately in patients with either early or long term arthritis.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cut-Offs and Response Criteria for the Hospital Universitario La Princesa Index (HUPI) and Their Comparison to Widely-Used Indices of Disease Activity in Rheumatoid Arthritis

et al. 2016

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Measures of Rheumatoid Arthritis Disease Activity

Johnson

Michaud

England

2020

Arthritis Care & Research

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Biologic therapy response and drug survival for females compared to males with rheumatoid arthritis: a cohort study

et al. 2014

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Prior research has identified differences between sexes in rheumatoid arthritis (RA) disease characteristics and treatment response, but not how these differences affect therapeutic decision making to switch therapy. Our objective was to assess for sex differences in RA disease activity during the course of biologic therapy and how these differences impact drug survival and therapeutic switching. Data from the Alberta Biologics Pharmacosurveillance Program, a population-based observational cohort of patients receiving biologic therapy for RA, were used for a sex-stratified analysis of disease activity. Linear mixed-model analysis was applied to compare continuous effectiveness outcomes (DAS28, HAQ scores, visual analogue scales of patient-reported outcomes). Chi-squared tests and log-rank tests were used to determine differences in the frequency of switching and drug survival between females and males. At biologic initiation, females (n = 419) and males (n = 148) had similar disease activity (DAS28 in females 5.83, males 5.72), but females reported worse function (HAQ 1.64 vs 1.51, p = 0.037) and more fatigue (6.7 vs 5.9/10, p = 0.013), but the same global score as males (6.9 vs 6.8/10). During biologic therapy, females reported more fatigue (β = -0.454, 95 % CI -0.852, -0.056, p = 0.0252), worse function (β = -0.183, 95 % CI -0.291, -0.074, p = 0.0010) and higher DAS28 scores (β = -0.401, 95 % CI -0.617, -0.184, p = 0.0003). A new composite disease activity index, the HUPI, eliminated the observed differences in disease activity scores between females and males. Median survival for biologic-naïve patients was similar between sexes (3.7 years males, 3.3 years females, log-rank test p = 0.25). The frequency of switching and survival on subsequent biologics were the same between females and males. Guided by traditional outcome measurement tools, worse disease activity and patient-reported outcomes through the course of therapy did not translate into differences in drug survival or more frequent switching for females on biologic therapy for RA.

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Development and Validation of a New Disease Activity Index as a Numerical Sum of Four Variables in Patients With Early Arthritis

Cited by 12 publications

References 33 publications

Cut-Offs and Response Criteria for the Hospital Universitario La Princesa Index (HUPI) and Their Comparison to Widely-Used Indices of Disease Activity in Rheumatoid Arthritis

Cut-Offs and Response Criteria for the Hospital Universitario La Princesa Index (HUPI) and Their Comparison to Widely-Used Indices of Disease Activity in Rheumatoid Arthritis

Measures of Rheumatoid Arthritis Disease Activity

Biologic therapy response and drug survival for females compared to males with rheumatoid arthritis: a cohort study

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