The authors declare that they have no competing interest.
NH-H, FA and HR helped to correction of the article. LL, SEk, LM and AN participated in collection of patients and fill the questionnaire. All authors have read and approved the final manuscript.
Clinical disease activity index (CDAI) and simplified disease activity index (SDAI) are useful tools for the evaluation of disease activity in patients with rheumatoid arthritis (RA), but have not been comparatively validated in Moroccan population. Therefore, this study was designed to assess validity and reliability of CDAI and SDAI in comparison to disease activity score-28 joints (DAS-28) in Moroccan patients with RA.
Patients with RA were included in a cross-sectional study. Patient characteristics and RA were collected. The disease activity was assessed by DAS-28, CDAI and SDAI. Patients were splitted into groups of remission, low, moderate and high activity on the basis of predefined cut-offs for DAS-28, CDAI, and SDAI. A Spearman correlation between composite indexes and inter-group comparison of the indexes were performed. Using DAS-28 as a gold standard, the Receiver operator characteristic (ROC) curve was used to assess the performance of a screening test at different levels.
The study was conducted with 103 patients of female predominance (87.4 %). Mean age was 49.7 ± 11.4 years. Median disease duration was in the order of 8 years [3-14]. There was an excellent correlation between DAS-28 and CDAI (r = 0.95, p <0.001), CDAI and SDAI (r = 0.90, p <0.001), and DAS-28 and SDAI (r = 0.92, p <0.001). There was a good inter-rater alignment between the DAS-28 and CDAI (Weighted kappa =0.743) and there was a moderate inter-rater alignment between the DAS-28 and SDAI (Weighted kappa =0.60), and also between the SDAI and CDAI (Weighted kappa = 0.589). There was no statistically significant difference between AUROC of CDAI and SDAI as both were performed equally well.
This study is the first Moroccan case study to compare the performance of both CDAI and SDAI in evaluation of disease activity in patients with RA. Our study showed that there was a direct and excellent correlation between DAS-28 and CDAI, and SDAI and DAS-28.
Our study shows a strong positive correlation between DAS-28, CDAI and SDAI. The cut-off values for CDAI and SDAI used in western literature can be used with minor modifications in Moroccan scenario.
Goekoop-Ruiterman YP, de Vries-Bouwstra JK, Kerstens PJSM, Nielen MMJ, Vos K, Schaardenburg D van, et al. DAS-driven therapy versus routine care in patients with recent-onset active rheumatoid arthritis. Ann Rheum Dis 2010;69:65–9.
Gaujoux-Viala C, Mouterde G, Baillet A, Claudepierre P, Fautrel B, Le Loët X, et al. Evaluating disease activity in rheumatoid arthritis: which composite index is best? A systematic literature analysis of studies comparing the psychometric properties of the DAS, DAS28, SDAI and CDAI. Joint Bone Spine. 2012;79:149–55.
Pincus T. The American College of Rheumatology (ACR) Core 3: data set and derivative “patient only” indices to assess rheumatoid arthritis. Clin Exp Rheumatol. 2005;23 Suppl 39:S109–13. PubMed
DAS 28 - Disease Activity Score Calculator for Rheumatoid Arthritis. The online software http://www.4s-dawn.com/DAS28/DAS28.html. (accessed: January 2012).
Arya V, Malaviya AN, Raja RR. CDAI (clinical disease activity index) in rheumatoid arthritis: cut-off values for classification into different grades of disease activity. Indian J Rheumatol. 2007;2(3):91–4. CrossRef
Aletaha D, Smolen J. The Simplified Disease Activity Index (SDAI) and the Clinical Disease Activity Index (CDAI): a review of their usefulness and validity in rheumatoid arthritis. Clin Exp Rheumatol. 2005;23 Suppl 39:S100–8. PubMed
Altman DG. Practical statistics for medical research. London: Chapman and Hall; 1991.
SMOLENJS. The work of the EULAR Standing Committee on International Clinical Studies Including Therapeutic Trials (ESCISIT). Br J Rheumatol. 1992;31:219–20. CrossRef
Malibiradar S, Kumar Singh A, Kumar A, Kumar Jha R. Comparative validation of clinical disease activity index (CDAI) and simplified disease activity index (SDAI) in rheumatoid arthritis in India. Indian J Rheumatol. 2013;8:102–6. CrossRef
- Reliability and validity of CDAI and SDAI indices in comparison to DAS-28 index in Moroccan patients with rheumatoid arthritis
Imane Ben Slama
Sarra El kabbaj
Najia Hajjaj - Hassouni
- BioMed Central
Neu im Fachgebiet Orthopädie und Unfallchirurgie
Mail Icon II