Development and validation of handy rheumatoid activity score with 38 joints (HRAS38) in rheumatoid arthritis patients receiving infliximab

Abstract

The parameters involved in the Disease Activity Score of 28 joints (DAS28) are not mutually independent, and the evaluation excludes ankle and foot joints. We developed a new quantitative and comprehensive assessment of the activity of rheumatoid arthritis (RA), called the handy rheumatoid activity score, with 38 joints (HRAS38), to overcome these disadvantages of DAS28. Forty-six RA patients who recently completed a 1-year infliximab therapy were evaluated for DAS28 (C-reactive protein; CRP) and HRAS38 at 0, 2, 6, 14, 22, 30, 38, 46, and 54 weeks. The 38-joint evaluation in HRAS38 includes 28 joints of DAS28 except for the shoulder joints, with the addition of ankle and metatarsophalangeal joints. The extent of joint swelling was rated on a scale of 0-3. The HRAS38 score is the cumulative sum of three parameters including: (1) a global assessment of disease activity [visual analog scale (VAS) 0-100 mm] by the patient, (2) swollen joint score based on a 38-joint assessment by a physician (0-114), and (3) serum concentration of CRP (mg/l). Scatter plots of HRAS38 and DAS28(CRP), and subsequent linear regression analysis demonstrated a statistically significant correlation between methodologies (r = 0.846, P < 0.0001). Infliximab treatment resulted in a statistically significant (P < 0.001) decrease in the mean HRAS38 score from 130.5 to 56.5 within 2 weeks of treatment and at 52 weeks of therapy scores were still reduced at 52.5. The mean DAS28(CRP) was also significantly (P < 0.001) reduced from a baseline value of 5.8 to 3.7 after 2 weeks treatment with a final value of 3.2 after 52 weeks of therapy. Infliximab reduced the progression of joint destruction by 85%, for terms before infliximab as determined by radiographic analyses. The degree of progression appeared to be associated with the mean HRAS38, although this observation was not shown to be statistically significant by regression analysis (r = 0.307). The HRAS38 score comprises minimal and independently acquired parameters and is an effective and comprehensive measure of disease activity in RA patients.

Etanercept (ETN) with methotrexate (MTX) is better than ETN monotherapy in patients with active rheumatoid arthritis despite MTX therapy: a randomized trial

“…However, the overall efficacy at this dose in Japanese RA patients is acceptable, as previously described: remission in 11% and non-remission improvement (at least 50% improvement in arthritis and serum CRP level) in 41% [14]. Moreover, the clinical and radiographic efficacy of infliximab added to MTX 7-9 mg/ week in Japan [9,[15][16][17] was comparable to that seen in ATTRACT [18,19] and ASPIRE studies [20]. Because of the lack of available data concerning MTX doses in Japanese RA patients living abroad, it has not yet been determined whether a similar dose of MTX to that used in many other countries (10-25 mg/week) is also appropriate for Japanese RA patients.…”

“…M group than the E group at weeks 4 (p = 0.02), 8 (p = 0.009), 12 (p = 0.001) and 24 (p = 0.0003) with the Mann-Whitney U test. The improvement in the disease activity was also evaluated by the handy RA activity score with 38 joints (HRAS38), in which the cut-off values for low disease activity and high disease activity are 50 and 100, respectively [9]. The HRAS38 score is the cumulative sum of a global assessment of disease activity by the patient (0-100), a swollen joint score graded from 0 to 3 based on a 38-joint assessment by a physician (0-114), and the serum CRP level (mg/l).…”

Retrospective clinical study on the notable efficacy and related factors of infliximab therapy in a rheumatoid arthritis management group in Japan: one-year outcome of joint destruction (RECONFIRM-2J)

“…Although the clinical efficacy and safety of infliximab therapy in Japanese patients with RA has now been explored [15,16], only a few reports have examined the effect of infliximab on structural damage [17]. In this report, we studied 67 RA patients among the 410 patients enrolled in the RECON-FIRM-2 study and analyzed the structural damage in these patients using the modified vdH-Sharp scoring method at 0 weeks as well as at 54 weeks after the start of infliximab therapy.…”

“…In a previous study, we demonstrated that the estimated yearly progression rate was extremely high in Japanese RA patients before the start of infliximab therapy [17], and that the progression rate was suppressed by treatment with infliximab for one year [17]. This data was collected at a single center, and the patients who were recruited for the study were longstanding RA patients who had been waiting for a long time for anti-TNF inhibitors to be approved.…”

Differences between the Health Assessment Questionnaire Disability Index (HAQ-DI) and the modified HAQ (mHAQ) score before and after infliximab treatment in patients with rheumatoid arthritis

“…Consequently, biological agents targeting TNF-a are effective not only in controlling synovial inflammation, but also in halting structural damage to the joints, contributing to better HAQ-DI values [11][12][13][14]. Indeed, in Japan, the efficacy of infliximab in the control of RA activity and the halting of radiographic progression has been demonstrated with even a relatively low dose of methotrexate (MTX) [15][16][17][18]. However, differences in the temporal changes between the HAQ-DI and the mHAQ score in RA patients actively receiving treatment with biological agents have not been elucidated.…”