类风湿关节炎活动期临床判断.ppt
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1、,类风湿关节炎活动度临床判断,Clinical Assessment of Rheumatoid Arthritis Disease Activity(Partly quoted from Jonathan Kay,MD),Content,Why quantify RA disease activity?Composite disease activity indicesResponse criteria for clinical trialsPatient-reported outcome measuresQuantitatively-driven therapy for early RAD
2、ata collection tools,Shaw on Measurement,“The only man who behaved sensibly was my tailor;he took my measure anew every time he saw me,whilst all the rest went on with their old measurements and expected them to fit me.”-George Bernard Shaw(1856-1950),How to quantify RA disease activity,Clinical com
3、posite indices-DAS/DAS28-SDAS-CDAIPatient-reported outcome measuresImaging-Plain radiographs-Musculoskeletal ultrasound-MRI,Primary site of RA disease activityPersistent synovitis results in-Joint destruction-DisabilityGoal of treatment(remission)is absence of synovitisTender&swollen joint counts ar
4、e outcome upon which therapeutic decisions are based,Why Assess Joints?,Reported as%improvement,comparing disease activity at two discrete time points-ACR20 is 20%improvement-ACR50 is 50%improvement(ACR50 responders include ACR20 responders)-ACR70 is 70%improvement(ACR70 responders include ACR20 and
5、 ACR50 responders)Used to maximally discriminate effective treatment from placebo treatment in clinical trialsNot directly applicable to clinical practice DT Felson et al.Arthritis Rheum.1995;38(6):727-735,ACR response criteria:the traditional dichotomous benchmark,Disease Activity Score(DAS)DAS28Si
6、mplified Disease Activity Index(SDAI)(简化的DAS评分)Clinical Disease Activity Index(CDAI)(临床DAS评分),Continuous Measures of RA Disease Activity,DAS=0.54(Tender 44)1/2+0.06(Swollen 66)1/2+0.33 In(ESR)+0.007(Global Health on VAS)(44个压痛关节、66个肿胀关节)Provides absolute indication of RA disease activity on a scale
7、of 1 to 9-DAS 3.6=high disease activity-DAS 2.4-3.6=moderate disease activity-DAS 1.6-2.4=low disease activity-DAS 1.6=remissionDM van der Heijde et al.J Rheumatol 1993;20:579-81,Disease Activity Score(DAS):A continuous measure,Simplified disease activity score using 28-joint count-Integrates measur
8、es of physical examination,acute phase response,and patient self-assessmentDAS28=0.56(Tender 28)1/2+0.28(Swollen 28)1/2+0.70 In(ESR)+0.014(Global Health on VAS)Provides absolute indication of RA disease activity on a scale of 0.49 to 9.07-DAS28 5.1=high disease activity-DAS28 3.2-5.1=moderate diseas
9、e activity-DAS28 2.6-3.2=low disease activity-DAS28 2.6=remission DM van der Heijde et al.J Rheumatol 1993;20:579-81,DAS28:A simplified disease activity score,Joints Assessed in DAS&DAS28,Joints assessed only in DAS,Joints assessed in DAS&DAS28,TJC and SJC contribute numerically to 50%of DAS/DAS28ES
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- 关 键 词:
- 类风湿 关节炎 活动 临床 判断
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