Comparison between DAS28, CDAI and HAQ-DI as tools to monitor early rheumatoid arthritis patients in eastern India

To investigate the relationship among DAS28, CDAI and HAQ-DI in early rheumatoid arthritis (RA) patients. It was a prospective study on 61 consecutive DMARD naive early RA patients attending the outpatient department of a tertiary care hospital in eastern India. DAS28, CDAI and HAQ-DI were calculated at the initial visit. They were put on DMARD therapy as per protocol with categorization of disease activity as per the CDAI values. DAS28, CDAI and HAQ-DI were again calculated after 3 months. Statistical analysis was carried out. There was a significant correlation among HAQ-DI, DAS28 and CDAI values. HAQ-DI showed significant correlation with the individual variables used in CDAI and DAS28. These observations were noted both in the initial and after 3-month follow-up values. There was significant agreement between the disease activity categories obtained by CDAI and DAS28 cut-off levels. Combination DMARD therapy based on ACR 2008 recommendations resulted in significant improvement in disease activity and functional disability. We can assess the disease activity in the patients by recording the HAQ-DI, at least in cases of early RA. Both DAS28 and CDAI are equally useful in assessing the disease activity of RA. These facts become important as it suggests that laboratory values do not remain absolutely essential in the assessment of the patients. These findings are especially important in a fund-stricken health system in developing countries like India.