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07-09-2018 | Treatment | Feature | Article

At a glance: Common scores used in rheumatology

A number of different scores, many of them composite outcomes, are used in daily rheumatology practice and in clinical trials to assess the efficacy of new treatments. This article provides a quick-reference guide to the criteria that are commonly used, together with an explanation of the component parts making up the individual scores.

Rheumatoid arthritis


DAS28

Disease activity score at 28 joints

Definition: A combined index providing a measure of disease activity, comprising:

  1. the number of swollen joints (of a possible 28);
  2. the number of tender joints (of a possible 28); and
  3. either erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) level (DAS28-ESR and DAS28-CRP, respectively).
Link to further information: http://www.das-score.nl/das28/en/

VAS

Visual analog scale
Definition: A psychometric response scale for parameters that range across a continuum of values, such as pain. The VAS pain scale ranges from “no pain” to “worst pain,” and patients mark a line to indicate how they are feeling.
Link to further information:https://www.arthritis.org/living-with-arthritis/treatments/plan/remission/measuring-disease-activity.php

HAQ-DI

Health Assessment Questionnaire Disability Index
Definition: The physical function scale of the HAQ, including 20 items in eight categories representing activities including dressing, eating, walking, grip, and reach.
Link to further information:http://www.clinexprheumatol.org/article.asp?a=2681

CDAI

Clinical Disease Activity Index

Definition: A composite index for assessing disease activity based on:

  1. swollen joint count (of a possible 28);
  2. tender joint count (of a possible 28);
  3. patient’s global assessment of disease activity (VAS); and
  4. physician’s global assessment of disease activity (VAS).
Link to further information: https://arthritis-research.biomedcentral.com/articles/10.1186/ar1740

SDAI

Simplified Disease Activity Index

Definition: The numerical sum of five measures:

  1. swollen joint count (of a possible 28);
  2. tender joint count (of a possible 28);
  3. patient’s global assessment of disease activity (VAS);
  4. physician’s global assessment of disease activity (VAS); and
  5. levels of CRP.
Link to further information: https://academic.oup.com/rheumatology/article/42/2/244/1788401

ACR20/50/70 response

American College of Rheumatology response criteria
Definition: At least a 20%, 50%, or 70% improvement in the number of tender and swollen joints, and at least a 20%, 50%, or 70% improvement in three of the following five criteria:
  1. patient global VAS;
  2. patient pain VAS;
  3. physician global VAS;
  4. HAQ score;
  5. acute-phase reactant value (ESR or CRP).

Link to further information: https://www.rheumatology.org/Portals/0/Files/ACR_Core_Disease_Activity_RA_Clinical_Trials93.pdf

EULAR response

European League Against Rheumatism response criteria
Definition: Response criteria based on the DAS28 index.

Good response: More than a 1.2-point improvement in DAS28, with a present score of 3.2 points or lower.

Moderate response: More than a 1.2-point improvement in DAS28, with a present score of more than 3.2 points, or an improvement in DAS28 of >0.6 to ≤1.2 points, with a present score of 5.1 points or lower.
No response: Improvement in DAS28 of >0.6 to ≤1.2 points, with a present score of more than 5.1 points, or an improvement in DAS28 of 0.6 points or less, regardless of present score.

Link to further information:https://onlinelibrary.wiley.com/doi/epdf/10.1002/art.1780390105

mTSS score

Modified total Sharp/van der Heijde score

Definition: A standard scoring method for analyzing radiographs to assess disease progression.

Link to further information:https://ard.bmj.com/content/62/7/597


Osteoarthritis


WOMAC score

Western Ontario and McMaster Universities Osteoarthritis Index
Definition: Self-reported 24-item scale used to measure disease activity in patients with osteoarthritis, based on pain, stiffness, and physical function.
Links to further information: https://www.rheumatology.org/I-Am-A/Rheumatologist/Research/Clinician-Researchers/Western-Ontario-McMaster-Universities-Osteoarthritis-Index-WOMAC
https://europepmc.org/abstract/med/3068365

KOOS

Knee injury and Osteoarthritis Outcome Score

Definition: An extension of the WOMAC score developed with the purpose of evaluating long- and short-term symptoms and function in people with osteoarthritis and knee injury. The KOOS includes five self-reported subscales:

  1. pain;
  2. other symptoms;
  3. function in daily living;
  4. function in sport and recreation;
  5. knee-related quality of life.
Link to further information:https://www.jospt.org/doi/10.2519/jospt.1998.28.2.88


Ankylosing spondylitis


BASDAI

Bath Ankylosing Spondylitis Disease Activity Index

Definition: A measure of disease activity in patients with ankylosing spondylitis, including patient-reported levels of:

  1. back pain;
  2. fatigue;
  3. peripheral joint pain and swelling;
  4. localized tenderness; and
  5. duration and severity of morning stiffness.

Links to further information:http://basdai.com/
https://onlinelibrary.wiley.com/doi/full/10.1002/acr.20575

BASFI

Bath Ankylosing Spondylitis Functional Index
Definition: A self-assessed measure of functional ability for patients with ankylosing spondylitis.
Links to further information:http://basdai.com/BASFI.php  https://onlinelibrary.wiley.com/doi/full/10.1002/acr.20575

SASSS

Stoke Ankylosing Spondylitis Spinal Score
Definition: Radiographic scoring system in ankylosing spondylitis that evaluates the lumbar spine at the posterior and anterior corners for erosions, sclerosis, squaring, total bony bridging, and syndesmophytes.
Link to further information:https://www.ncbi.nlm.nih.gov/pubmed/10229435

mSASSS

modified Stoke Ankylosing Spondylitis Spinal Score
Definition: A modification of the SASSS with the addition of a score for the cervical spine and the definition of how to identify squaring. mSASSS is the sum of the lumbar and cervical spine score, and has a range of 0–72 points.
Link to further information: https://ard.bmj.com/content/64/1/127

ASDAS

Ankylosing Spondylitis Disease Activity Score
Definition: A composite index to assess disease activity in ankylosing spondylitis patients, combining five variables to give a single disease activity score. The ASDAS is based on CRP (preferred version) or ESR, and takes back pain, morning stiffness, and peripheral pain/swelling into account.
Link to further information: https://ard.bmj.com/content/70/1/47

ASAS20/40/50/70 response

Assessment of SpondyloArthritis international Society response criteria 

Definition: At least a 20%, 40%, 50%, or 70% improvement and an absolute improvement of at least 1 unit on a scale of 1–10 in at least three of the following criteria:

  1. patient global assessment;
  2. pain;
  3. function (BASFI); and
  4. inflammation (duration and severity of morning stiffness as measured by BASDAI).
Link to further information: https://onlinelibrary.wiley.com/doi/abs/10.1002/1529-0131(200108)44:8%3C1876::AID-ART326%3E3.0.CO%3B2-F


Psoriatic arthritis


ACR20/50/70 response (also used in rheumatoid arthritis)

American College of Rheumatology response criteria
Definition: At least a 20%, 50%, or 70% improvement in the number of tender and swollen joints, and at least a 20%, 50%, or 70% improvement in three of the following five criteria:
  1. patient global VAS;
  2. patient pain VAS;
  3. physician global VAS;
  4. HAQ score;
  5. acute-phase reactant value (ESR or CRP).

Link to further information: https://www.rheumatology.org/Portals/0/Files/ACR_Core_Disease_Activity_RA_Clinical_Trials93.pdf

mTSS score (also used in rheumatoid arthritis)

Modified total Sharp/van der Heijde score

Definition: A standard scoring method for analyzing radiographs to assess disease progression.

Link to further information:https://ard.bmj.com/content/62/7/597

PASI75/90 response

Psoriasis Area and Severity Index response criteria
Definition: At least a 75% or 90% improvement in the PASI, a widely used tool to assess the severity and coverage of psoriasis.

Links to further information: https://www.pasitraining.com/
https://onlinelibrary.wiley.com/doi/abs/10.1111/jdv.12817

Systemic lupus erythematosus


SLEDAI

Systemic Lupus Erythematosus Disease Activity Measure
Definition: A global index of systemic lupus erythematosus (SLE) disease activity over the previous 10 days, including measures of manifestations in nine organ systems.

Links to further information: https://www.clinexprheumatol.org/article.asp?a=8761 
https://onlinelibrary.wiley.com/doi/pdf/10.1002/art.1780350606

SELENA-SLEDAI

Safety of Estrogen in Lupus Erythematosus National Assessment-Systemic Lupus Erythematosus Disease Activity Measure
Definition: A modification of the SLEDAI index by the SELENA (Safety of Estrogen in Lupus Erythematosus National Assessment) group during a randomized trial investigating contraceptive use in SLE patients. The update included the addition of a glossary, and modification of the scoring to account for persistent active disease in the form of rash, mucosal ulcers, and alopecia.

Links to further information: https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-015-0702-6
https://www.clinexprheumatol.org/article.asp?a=8761

SLEDAI-2K

Systemic Lupus Erythematosus Disease Activity Measure-2002
Definition: A modification of the SLEDAI index introduced in 2002 to allow documentation of persistent disease activity manifesting as rash, alopecia, mucosal ulcers, and proteinuria.
Links to further information: http://www.jrheum.org/content/29/2/288.long
https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-015-0702-6
https://www.clinexprheumatol.org/article.asp?a=8761

BILAG

British Isles Lupus Assessment Group index
Definition: A score providing measures of disease activity across eight organ systems on a scale of A (most severe, indicating that a patient requires treatment with prednisolone 20 mg daily or immunosuppressive therapy) to E (indicating that the disease has never been active). The original index was published in 1988.
Links to further information: https://academic.oup.com/rheumatology/article/55/8/1357/2566467
https://www.ncbi.nlm.nih.gov/pubmed/11199918
https://onlinelibrary.wiley.com/doi/abs/10.1002/acr.20572

BILAG-2004

British Isles Lupus Assessment Group index-2004
Definition: An updated version of the BILAG index, published in 2005, which measures disease manifestation in nine systems.
Links to further information: https://academic.oup.com/rheumatology/article/55/8/1357/2566467
https://www.ncbi.nlm.nih.gov/pubmed/11199918
https://onlinelibrary.wiley.com/doi/abs/10.1002/acr.20572

SLE Responder Index (SRI)


Systemic lupus erythematosus responder index

Definition: A composite index to measure disease activity, defined as:

  1. at least a 4-point reduction in the SELENA-SLEDAI score;
  2. no new BILAG A or no more than one new BILAG B domain score; and
  3. no more than a 0.3-point worsening in Physician’s Global Assessment.

Links to further information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2748175/
https://academic.oup.com/rheumatology/article/55/8/1357/2566467


Juvenile arthritis


JIA ACR30/50/70/90 response

Juvenile idiopathic arthritis response criteria

Definition: At least a 30%, 50%, 70%, or 90% improvement from baseline in any three of the following six variables in juvenile idiopathic arthritis (JIA) patients, with no more than one variable worsening by more than 30%:

  1. physician’s global assessment of disease activity;
  2. parent/guardian’s or patient’s global assessment of overall wellbeing;
  3. functional ability;
  4. number of joints with active arthritis;
  5. number of joints with limited range of motion; and
  6. ESR.
Link to further information: https://onlinelibrary.wiley.com/doi/abs/10.1002/art.1780400703

JADAS

Juvenile Arthritis Disease Activity Score

Definition: A composite disease activity score for JIA including four measures:

  1. physician’s global assessment of disease activity;
  2. parent/guardian’s or patient’s global assessment of overall wellbeing;
  3. number of joints with active arthritis; and
  4. ESR.

The JADAS-71 includes a complete joint count (71 joints) in addition to the other measures, while the JADAS-27 and JADAS-10 include reduced joint counts (27 and 10 joints, respectively).

Links to further information: https://onlinelibrary.wiley.com/doi/abs/10.1002/art.24516
https://ard.bmj.com/content/72/12/1983

JADAS-CRP

Juvenile Arthritis Disease Activity Score based on CRP
Definition: An alternative version of the JADAS score where ESR is substituted with CRP.
Link to further information: https://ard.bmj.com/content/71/7/1122

cJADAS

Clinical Juvenile Arthritis Disease Activity Score

Definition: A clinical three-item version of the JADAS score that excludes ESR or CRP. The cJADAS includes the following variables that are measured routinely in clinical settings:

  1. physician global assessment of disease activity;
  2. parent/guardian or patient global assessment of overall wellbeing; and
  3. number of joints with active arthritis.

Link to further information: https://doi.org/10.1136/annrheumdis-2012-202031

Wallace criteria

Criteria for inactive disease developed by Carol Wallace and colleagues.
Definition: Inactive disease defined as:
  1. no active arthritis;
  2. no fever, rash, serositis, splenomegaly, or generalized lymphadenopathy attributable to JIA;
  3. no active uveitis;
  4. normal ESR or CRP; and
  5. physician's global assessment of disease activity rated at the best score possible for the instrument used.
Link to further information: http://www.jrheum.org/content/31/11/2290.long

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