Clicky

TabletWise.com
Pharmacy Website
Clinic Website
 
 

Clinical Disease Activity Index (CDAI) for Rheumatoid Arthritis

Calculators  Musculoskeletal
The Clinical Disease Activity Index (CDAI) is a measure of rheumatoid arthritis (RA) disease severity that an be used continually through serial clinical encounters to determine disease progession.
Tender joint count
j
Swollen joint count
j
By considering all the ways arthritis affects the patient, ask the patient how well are they doing?
0.0 - Very well 0
0.5 0.5
1.0 1
1.5 1.5
2 2
2.5 2.5
3.0 3
3.5 3.5
4.0 4
4.5 4.5
5.0 5
5.5 5.5
6.0 6
6.5 6.5
7.0 7
7.5 7.5
8.0 8
8.5 8.5
9.0 9
9.5 9.5
10 - Very poor 10
Per medical opinion: By considering all the ways arthritis affects the patient, ask the patient how well are they doing?
0.0 - Very well 0
0.5 0.5
1.0 1
1.5 1.5
2 2
2.5 2.5
3.0 3
3.5 3.5
4.0 4
4.5 4.5
5.0 5
5.5 5.5
6.0 6
6.5 6.5
7.0 7
7.5 7.5
8.0 8
8.5 8.5
9.0 9
9.5 9.5
10 - Very poor 10
Result:

Background

Measured Factor
Severity of rheumatoid arthritis
Measured Factor Disease
  • RA remission
  • High severity of RA
  • Worsening RA severity
  • RA "flare up"
  • Moderate severity of RA
  • Low severity of RA
Measured Factor Detail
This clinical activity score uses only clinical data to assess RA disease activity and severity. Disease activity can increase or decrease, worsening or improving a patient's clinical disease classification respectively. It can be used to trend disease activity to determine a change in disease severity, and to determine or change the course of a patient's treatment, and to determine the effectiveness of an initiated therapy such as DMARDs (disease modifying antirheumatic drugs). Indicators of disease activity are the factors that go into the CDAI score such as the number of joints affected, measured for both tenderness and swelling, as well as a patients level of comfort/discomfort due to RA, and the clinicians overall view of the patient's disease severity. This score was developed for quick clinical assessment and does not take into account pertinent lab values.
Speciality
Rheumatologist
Body System
Musculoskeletal
Measured Factor Low Impact
  • RA remission
Measured Factor High Impact
  • Worsening RA severity
  • RA "flare up"
  • High severity of RA
  • Moderate severity of RA
  • Low severity of RA

Result Interpretation

Ranges Ranges
  • Critical High: Scores > 22.0
  • Normal: Scores ≤ 2.8
  • Normal Adult Male: Scores ≤ 2.8
  • Normal Adult Female: Scores ≤ 2.8
  • Normal Geriatric Male: Scores ≤ 2.8
  • Normal Geriatric Female: Scores ≤ 2.8
Result Low Conditions
  • RA remission
Result High Conditions
  • Worsening RA severity
  • RA "flare up"
  • High severity of RA
  • Moderate severity of RA
  • Low severity of RA
Test Limitations
The majority of data used in this disease activity score are subjective, which can be quite limiting to the tool. Those data include the patient's subjective self-assessment as well as the clinician's subjective assessment of how well the patient is doing at the time of assessment. Additionally, this tool was developed for ease of use and quick, clinical assessment so it does not take into account any pertinent lab values.
References: 1, 2

Studies

Study Validation 1
SIngh et al. conducted a cross-sectional study at Pt. BDS PGIMS, Rohtak India in 200 patients with rheumatoid arthritis (RA). The purpose of the study was to calculate Clinical Disease Activity Index (CDAI) scores for each patient and compare those to the calculated Disease Activity Score-28 (DAS-28) scores, to identify any existent correlation between the two scores. Patients were divided into 4 categories of disease activity: Group-I: Remission (DAS-28 < 2.6; CDAI < 2.8), Group II: Low disease activity (DAS-28 = 2.6-3.2; CDAI = 2.8-10), Group III: Moderate disease activity (DAS-28 = 3.2- 5.1; CDAI = 10-22), Group IV: High disease activity (DAS-28 > 5.1; CDAI > 22). The authors used Spearmen's correlation statistics and kappa statistics to evaluate the correlation between the CDAI scores with their DAS-28 scores. Group I showed mean DAS-28 of 1.99 ± 0.38; mean CDAI of 0.90 ± 0.65, (P = 0.0001). Group II showed mean DAS-28 of 3.04 ± 0.17; mean CDAI of 6.45 ± 02.35, (P = 0.0001). Group III showed mean DAS-28 of 4.25 ± 0.58; mean CDAI of 16.46 ± 3.31 (P < 0.0001). Group IV showed mean DAS-28 of 6.38 ± 0.87; mean CDAI of 38.56 ± 11.88 (P < 0.0001). Both scores demonstrated a statistically significant, moderate-to-good correlation between CDAI and DAS-28 scoring (k=0.533; p<0.0001). The investigators concluded that the CDAI scoring method is a good clinical tool that can facilitate clinican evaluation of disease activity. It is a convenient tool for clinicians to use as it does not require lab values and functions as a simple day-to-day tool for RA patient assessment.
References: 3
Study Validation 2
Aletaha et al. summarized the Clinical Disease Activity Index (CDAI) and its clinical usefullness and effectiveness in determining rheumatoid arthritis (RA) disease activity. They highlighted its accuracy with radiographic findings as well as its close correlation with other scores such as Health Assessment Questionaire (HAQ) and Disease Activity Score-28 (DAS-28). The authors focused on its clinical ease of use and applications. A major staple in RA treatment is to inititate pharmacological treatment as soon as possible to improve patient outcomes. The CDAI allows for immediate clinical decision-making without needing to wait for laboratory tests. They concluded that the development of simple scores such as CDAI, will ultimately improve disease outcomes significantly in the long run.
References: 4
Study Validation 3
Kumar et al. conducted a prospective comparison study of the utility of the following rheumatoid arthritis (RA) scores: Clinical Disease Activity Index (CDAI), Health Assessment Questionaire without Didability Index (HAQDI), Routine Assessment of Patient Index Data 3 (RAPID3). The investigators followed 100 adult patients with RA that was newly diagnosed and disease modifying antirhematic drug (DMARD) naive. The study took place in south India from January 2013 to June 2014. This sample population was chosen to represent a patient population that is deemed less literate and less financially fortunate than previously studied populations, because of the CDAI score's ease of use and its lack of laboratory result requirements. In this primarily middle-aged, female sample population, the authors found correlations of varying strength between certain scores. They discovered a significant positive correlation between the DAS28 and CDAI scoring (r=0.568; P<0.001); DAS28 and HAQ-DI (r=0.304; P=0.002) and DAS28 and RAPID3 (r=0.404; P<0.001). They observed a 'slight-to-fair' agreement  between DAS28 and CDAI (kappa-statistic=0.296). They determined the agreement between DAS28 and HAQ-DI (kappa-statistic=0.007) and RAPID3 (kappa-statistic=0.072) to be less robust. The authors concluded that, although the study was somewhat limited by is inpatient setting, small sample size, and lack of disease-severity diversity, the CDAI score has emerged as the prefered choice for rapid disease severity analysis in adult patients initally presenting with RA who have limited understanding and limited access to advanced healthcare settings and testing.
References: 5
Study Additional 1
Curtis et al. conducted their analysis in order to determine the minimum clinically important differences (MCID) in Clinical Disease Activity Index (CDAI) for improvement and worsening in early rheumatoid arthritis (RA) patients with low/moderate disease activity. The authors used data from Canadian Early Arthritis Cohort patients to examine absolute change in CDAI in the first year after enrollment, stratified by disease activity. A total of 578 patients and 1169 paired visits were analyzed to determine difference. The investgators found that the MCID for CDAI was highly variable dependent on the patient's starting level of disease severity/activity. For patients who began in high disease activity with CDAI >22, they determined that the MCID for improvement in the CDAI was 12 units. Accordingly, for those starting in moderate disease activity with CDAI 10-22, the MCID  for improvement was 6 units. And the MCID  for improvement was 1 unit for low disease activity with CDAI <10. Upon assessment for disease worsening, they found that a change of 2 units or more would represent clinically significant worsening of RA activity among patients who achieved low disease activity. The authors recognize that the external validity of their study may be limited to the patient population with recently diagnosed/early RA, and may not be applicable to those with more established/severe RA. Therefore, they recommend the use of thresholds that discriminate based on baseline disease severity when analyzing patients. The authors conclude that their established MCID for absolute change in CDAI scores can be used to evaluate disease improvement and worsening in a setting of usual care, as well as increase the usefullness of CDAI scoring in clinical practice.
References: 6

Authors

Daniel Aletha
Medical University of Vienna, Doctor of medicine (MD)
Consultant rheumatologist and Associate Professor, Medical University of Vienna
Research Interests: His major research interests are outcomes research, clinical trials, and translational research in rheumatoid arthritis and other inflammatory rheumatic diseases. Dr. Aletaha has been involved in several International Task Forces, including the development of the 2010 Classification Criteria for RA. He is past chairman of the EULAR Standing Committee on Clinical Affairs (ESCCA), and editorial board member of a number of rheumatology specialty journals. Daniel Aletaha has authored more than 160 publications.
https://f1000.com/prime/thefaculty/member/1325463230134434

References

  1. Aletaha D, Nell VP, Stamm T, Uffmann M, Pflugbeil S, Machold K, et al. Acute phase reactants add little to composite disease activity indices for rheumatoid arthritis: validation of a clinical activity score. Arthritis Res Ther. 2005;7(4):R796-806.
  2. Anderson J, Caplan L, Yazdany J, Robbins ML, Neogi T, Michaud K, Saag KG, O'Dell JR, Kazi S. Rheumatoid arthritis disease activity measures: American College of Rheumatology recommendations for use in clinical practice. Arthritis Care Res (Hoboken). 2012 May;64(5):640-7.
  3. Singh H, Kumar H, Handa R, Talapatra P, Ray S, Gupta V. Use of clinical disease activity index score for assessment of disease activity in rheumatoid arthritis patients: an Indian experience. Arthritis. 2011;2011:146398.
  4. Aletaha D, Smolen JS.The Simplified Disease Activity Index (SDAI) and Clinical Disease Activity Index (CDAI) to monitor patients in standard clinical care. Best Pract Res Clin Rheumatol. 2007 Aug;21(4):663-75.
  5. Kumar BS, Suneetha P, Mohan A, Kumar DP, Sarma KVS. Comparison of Disease Activity Score in 28 joints with ESR (DAS28), Clinical Disease Activity Index (CDAI), Health Assessment Questionnaire Disability Index (HAQ-DI) & Routine Assessment of Patient Index Data with 3 measures (RAPID3) for assessing disease activity in patients with rheumatoid arthritis at initial presentation. Indian J Med Res. 2017 Nov; 146(Suppl 2): S57–S62. PMCID: PMC5890597.
  6. Curtis JR, Yang S, Chen L, Pope JE, Keystone EC, Haraoui B, et al. Determining the Minimally Important Difference in the Clinical Disease Activity Index for Improvement and Worsening in Early Rheumatoid Arthritis Patients. Arthritis Care Res (Hoboken). 2015 Oct;67(10):1345-53.