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Determining a low disease activity threshold for decision to maintain disease-modifying antirheumatic drug treatment unchanged in rheumatoid arthritis patients |
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| Authors: | Michel de Bandt Bruno Fautrel Jean Francis Maillefert Jean Marie Berthelot Bernard Combe René-Marc Flipo Frédéric Lioté Olivier Meyer Alain Saraux Daniel Wendling Xavier Le Loët Francis Guillemin |
| Institution: | 1. Centre hospitalier d'Aulnay sous Bois, Service de Rhumatologie, Boulevard Ballanger, Aulnay sous Bois, F-93600, France 2. APHP-GH Pitié Salpêtrière, Service de Rhumatologie, UFR de Médecine, Université Paris VI - Pierre et Marie Curie, 83 boulevard de l'H?pital, 75651, Paris cedex 13, France 3. H?pital du Bocage, Service de Rhumatologie, Centre Hospitalo-Universitaire du Dijon, 3 rue du faubourg Raynes, Dijon, F-21000, France 4. INSERM ERI 7 (EA 3822),Hotel-Dieu, Service de Rhumatologie, Centre Hospitalo-Universitaire de Nantes, 1 Place Alexis Ricordeau, Nantes, F-44000, France 5. H?pital Lapeyronie, Service de Rhumatologie, Centre Hospitalo-Universitaire du Montpellier, 371 avenue du Doyen Gaston Giraud, Montpellier, F-34000, France 6. Service de Rhumatologie, Centre Régional Hospitalo-Universitaire de Lille, Rue du Pr E Laine, Lille, F-59000, France 7. Centre Viggo-Petersen, Service de Rhumatologie, H?pital Lariboisière, 2 rue A Paré, Paris, F-75010, France 8. UFR de Médecine - Bichat Lariboisière, Service de Rhumatologie, Université Paris 7, APHP, Groupe hospitalier Bichat - Claude Bernard, 46 rue H Huchard, Paris, F-75018, France 9. H?pital de la Cavale Blanche, Service de Rhumatologie, Centre Hospitalo-Universitaire de Brest, rue T Prigent, Brest, F-29000, France 10. EA3186 - Agents pathogènes et Inflammation, Centre Hospitalo - Universitaire de Besan?on, H?pital Jean Minjoz, Service de Rhumatologie, Université de Franche-Comté, 1 Bd Fleming, Besan?on, F-25000, France 11. Department of Rheumatology, Rouen University Hospital & Inserm U905 (IFRMP 23), University of Rouen, 1 rue de Germont, Rouen, F-76230, France 12. INSERM CIC-EC, CHU de Nancy - H?pital Marin, 92 av Mal de Lattre de Tassigny, 54035, Nancy cedex, France 13. EA4003, Ecole de Santé Publique, Faculté de Médecine de Nancy, Université Henri Poincaré Nancy I, Nancy, F-54000, France |
| Abstract: | IntroductionThe aim of this study was to determine a low disease activity threshold - a 28-joint disease activity score (DAS28) value - for the decision to maintain unchanged disease-modifying antirheumatic drug (DMARD) treatment in rheumatoid arthritis patients, based on expert opinion.MethodsNine hundred and sixty-seven case scenarios with various levels for each component of the DAS28 (resulting in a disease activity score between 2 and 3.2) were presented to 44 panelists. For each scenario, panelists had to decide whether or not DMARD treatment (excluding steroids) could be maintained unchanged. In each scenario, for decision, the participants were given the DAS28 parameters, without knowledge of the resultant DAS28. The relationship between panelists' decision, DAS28 value, and components of the score were analysed by multiple logistic regression analysis. Each panelist analysed 160 randomised scenarios. Intra-rater and inter-rater reproducibility were assessed.ResultsForty-four panelists participated in the study. Inter-panelist agreement was good (κ = 0.63; 95% confidence interval = 0.61 to 0.65). Intra-panelist agreement was excellent (κ = 0.87; 95% confidence interval = 0.82 to 0.92). Quasi-perfect agreement was observed for DAS28 ≤ 2.4, less pronounced between 2.5 and 2.9, and almost no agreement for DAS28 > 3.0. For values below 2.5, panelists agreed to maintain unchanged DMARDs; for values above 2.5, discrepancies occurred more frequently as the DAS28 value increased. Multivariate analysis confirmed the relationship between panelist's decision, DAS28 value and components of the DAS28. Between DAS28 of 2.4 and 3.2, a major determinant for panelists' decision was swollen joint count. Female and public practice physicians decided more often to maintain treatment unchanged.ConclusionsAs a conclusion, panelists suggested that in clinical practice there is no need to change DMARD treatment in rheumatoid arthritis patients with DAS28 ≤ 2.4. |
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