Determining the Minimally Important Difference in the Clinical Disease Activity Index for Improvement and Worsening in Early Rheumatoid Arthritis Patients

J. R. Curtis, S. Yang, L. Chen, J. E. Pope, E. C. Keystone, B. Haraoui, G. Boire, J. C. Thorne, D. Tin, C. A. Hitchon, Clifton Bingham, V. P. Bykerk

Research output: Contribution to journalArticle

Abstract

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

Original languageEnglish (US)
Pages (from-to)1345-1353
Number of pages9
JournalArthritis Care and Research
Volume67
Issue number10
DOIs
StatePublished - Oct 1 2015

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Rheumatoid Arthritis
Sensitivity and Specificity
Pain Measurement
Arthritis
Joints
Health

ASJC Scopus subject areas

  • Rheumatology

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Determining the Minimally Important Difference in the Clinical Disease Activity Index for Improvement and Worsening in Early Rheumatoid Arthritis Patients. / Curtis, J. R.; Yang, S.; Chen, L.; Pope, J. E.; Keystone, E. C.; Haraoui, B.; Boire, G.; Thorne, J. C.; Tin, D.; Hitchon, C. A.; Bingham, Clifton; Bykerk, V. P.

In: Arthritis Care and Research, Vol. 67, No. 10, 01.10.2015, p. 1345-1353.

Research output: Contribution to journalArticle

Curtis, JR, Yang, S, Chen, L, Pope, JE, Keystone, EC, Haraoui, B, Boire, G, Thorne, JC, Tin, D, Hitchon, CA, Bingham, C & Bykerk, VP 2015, 'Determining the Minimally Important Difference in the Clinical Disease Activity Index for Improvement and Worsening in Early Rheumatoid Arthritis Patients', Arthritis Care and Research, vol. 67, no. 10, pp. 1345-1353. https://doi.org/10.1002/acr.22606
Curtis, J. R. ; Yang, S. ; Chen, L. ; Pope, J. E. ; Keystone, E. C. ; Haraoui, B. ; Boire, G. ; Thorne, J. C. ; Tin, D. ; Hitchon, C. A. ; Bingham, Clifton ; Bykerk, V. P. / Determining the Minimally Important Difference in the Clinical Disease Activity Index for Improvement and Worsening in Early Rheumatoid Arthritis Patients. In: Arthritis Care and Research. 2015 ; Vol. 67, No. 10. pp. 1345-1353.
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