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At a glance: Common scores used in rheumatology

09-07-2018
Rheumatology
Featured Content Creation

At a glance: Common scores used in rheumatology

Author: Claire Barnard

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: the number of swollen joints (of a possible 28); the number of tender joints (of a possible 28); and either erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) level (DAS28-ESR and DAS28-CRP, respectively).
Link to further information: https://clinicaltrials.gov/ct2/show/NCT01295827

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: swollen joint count (of a possible 28); tender joint count (of a possible 28); patient’s global assessment of disease activity (VAS); and 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: swollen joint count (of a possible 28); tender joint count (of a possible 28); patient’s global assessment of disease activity (VAS); physician’s global assessment of disease activity (VAS); and 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: patient global VAS; patient pain VAS; physician global VAS; HAQ score; 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

RAPID3 score

Routine assessment of patient index data 3 score
Definition: A pooled index to assess and monitor patients with rheumatoid arthritis without formal joint counts. RAPID3 comprises the three ACR Core Data Set measures – function, pain, and patient global estimate of status – to give a total score of 0–30, with a higher score indicating worse disease severity.
Links to further information: https://www.rheumatic.theclinics.com/article/S0889-857X(09)00077-5/fulltext https://www.rheumatology.org/Portals/0/Files/RAPID3%20Form.pdf

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

Kellgren–Lawrence score

Kellgren and Lawrence system for classification of osteoarthritis
Definition: A method based on radiographic measures for classifying the severity of knee osteoarthritis using five grades, from 0 (indicating no presence of osteoarthritis) to 4 (indicating severe osteoarthritis).
Links to further information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4925407/ https://radiopaedia.org/articles/kellgren-and-lawrence-system-for-classification-of-osteoarthritis-of-knee

ICOAP

Measure of Intermittent and Constant Osteoarthritis Pain
Definition: An 11-item measure for the assessment of pain in people with knee or hip osteoarthritis, taking into account intermittent and constant pain experiences.
Link to further information: https://www.oarsijournal.com/article/S1063-4584(07)00406-2/fulltext

OMERACT–OARSI criteria

Response criteria from the Outcome Measures in Rheumatology and Osteoarthritis Research Society International committees
Definition: A set of treatment response criteria based on pain and function. Response defined as: 50% or greater improvement in pain or function and an absolute change of at least 20 points; or 20% or greater improvement and absolute change of at least 10 points in at least two out of pain, function, and patient's global assessment.
Link to further information: https://www.oarsijournal.com/article/S1063-4584(04)00025-1/fulltext

Spondyloarthritis

BASDAI

Bath Ankylosing Spondylitis Disease Activity Index
Definition: A measure of disease activity in patients with ankylosing spondylitis, including patient-reported levels of: back pain; fatigue; peripheral joint pain and swelling; localized tenderness; and 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 5-item index developed to measure clinically significant changes in spinal movement.
Links to further information: https://onlinelibrary.wiley.com/doi/full/10.1002/acr.20575 https://ard.bmj.com/content/67/4/489.long

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: patient global assessment; pain; function (BASFI); and 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

CPDAI

Composite Psoriatic Disease Activity Index
Definition: A five-domain composite score taking into account joint disease, skin involvement, enthesitis, dactylitis and spinal disease. Each domain is graded from 0 to 3 points, giving a CPDAI range of 0–15.
Link to further information: https://ard.bmj.com/content/70/2/272

DAPSA

Disease Activity Index for Psoriatic Arthritis
Definition: A composite index originally developed for reactive arthritis, based on tender and swollen joint counts, patient pain assessment, patient global assessment, and CRP.
Link to further information: https://ard.bmj.com/content/75/5/811

GRACE

GRAppa Composite scorE
Definition: A composite score taking into account assessments of joints, skin, function, pain, and health-related quality of life. The GRACE score ranges from 0 (worst) to 10 (best) points.
Link to further information: https://www.jrheum.org/content/41/6/1212.long

PASDAS

Psoriatic Arthritis Disease Activity Score
Definition: A weighted index comprising assessments of joints, function, quality of life, acute-phase response, and patient and physician assessments.
Link to further information: https://www.jrheum.org/content/41/6/1212.long

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: patient global VAS; patient pain VAS; physician global VAS; HAQ score; 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

PASI75/90/100 response

Psoriasis Area and Severity Index response criteria
Definition: At least a 75%, 90%, or 100% 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

MDA

Minimal disease activity
Definition: A "satisfactory state" of disease activity defined according to the MDA criteria. MDA is defined as meeting five of the following seven criteria: tender joint count ⩽1; swollen joint count ⩽1; PASI ⩽1 or body surface area ⩽3; patient pain VAS ⩽15; patient global disease activity VAS ⩽20; HAQ ⩽0.5; and tender entheseal points ⩽1.
Link to further information: https://ard.bmj.com/content/69/01/48

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

cSLEDAI-2K

Clinical SLEDAI-2K
Definition: A variant of the SLEDAI-2K score in which the serologic parameters are omitted. The score can be used to evaluate SLE disease activity in clinical practice, where serologic test results are not always available.
Link to further information: http://www.jrheum.org/content/31/10/1934.long

BILAG

Clinical SLEDAI-2K
Definition: A variant of the SLEDAI-2K score in which the serologic parameters are omitted. The score can be used to evaluate SLE disease activity in clinical practice, where serologic test results are not always available.
Link to further information: http://www.jrheum.org/content/31/10/1934.long

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

BICLA


Definition: One or more gradation of improvement in BILAG scores in all body systems with moderate or severe disease activity at baseline; no new BILAG A or no more than one new BILAG B scores; no worsening of total SLEDAI score from baseline; no more than 10% deterioration in Physician’s Global Assessment score; and no initiation of non-protocol treatment.
Link to further information: https://lupus.bmj.com/content/1/1/e000005#ref-6

SLE Responder Index (SRI)

Systemic lupus erythematosus responder index
Definition: A composite index to measure disease activity, defined as: at least a 4-point reduction in the SELENA-SLEDAI score; no new BILAG A or no more than one new BILAG B domain score; and 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

LLDAS

Lupus Low Disease Activity State
Definition: A measure of low disease activity based on the following criteria: SLEDAI-2K of 4 points or less, with no activity in major organ systems and no hemolytic anemia or gastrointestinal activity; no new lupus disease activity since the previous assessment; SELENA-SLEDAI physician’s global assessment of disease activity score of 1 point or lower on a scale of 0–3 points; current prednisolone or equivalent dose of 7.5 mg/day or lower; and well-tolerated maintenance doses of immunosuppressive agents and approved biologics.
Link to further information: https://ard.bmj.com/content/75/9/1615

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

JADAS

Juvenile Arthritis Disease Activity Score
Definition: A composite disease activity score for JIA including four measures: physician’s global assessment of disease activity; parent/guardian’s or patient’s global assessment of overall wellbeing; number of joints with active arthritis; and ESR.
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: physician’s global assessment of disease activity; parent/guardian’s or patient’s global assessment of overall wellbeing; 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: no active arthritis; no fever, rash, serositis, splenomegaly, or generalized lymphadenopathy attributable to JIA; no active uveitis; normal ESR or CRP; and 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