:: Volume 28, Issue 3 (7-2020) ::
Journal of Ilam University of Medical Sciences 2020, 28(3): 70-79 Back to browse issues page
Evaluation of the Severity of Rheumatoid Arthritis based on Blood Sedimentation Rate and Sensitive Joints using a Longitudinal Model
Ayoub Poursafar1 , Mehdi Rahgozar * 2, Akbar Biglariyan1 , Masoumeh Akhlaghi3
1- Dept of Biostatistics, Tehran University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
2- Dept of Biostatistics, Tehran University of Social Welfare and Rehabilitation Sciences, Tehran, Iran , ma.rahgozar@uswr.ac.ir
3- Dept of Internal Medicine, Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
Abstract:   (2853 Views)
Introduction: Disease severity of Rheumatoid Arthritis is a latent concept which should be observed using a measurement tool. This variable plays a significant role in assessing disease status both cross-sectionally and longitudinally. The DAS28 scale is a valid instrument for assessing rheumatoid arthritis severity. This scale consists of two components, namely, the general system (blood sedimentation rate) and joint system (sensitive joints) as two correlated ordinal responses. The purpose of this study was to determine the process and affecting factors of the disease. This study aimed to present a marginalized random-effect model accompanied by the factors influencing these components. This method is used to assess the variables with associations simultaneously.
 
Materials & Methods: This study utilized the information of 107 patients with rheumatoid arthritis who referred to Shariati Hospital, Tehran, Iran, during 2016-18. The response variables were the general system and joint system of patients that were classified by rank. A marginalized random-effects model and a joint marginalized random-effects model were used and the best model was selected based on the minimum amount of AIC. Data were analyzed using SAS software (version 9.4). A p-value less than 0.05 was considered statistically significant. Ethics code: IR.USWR.REC.1397.045
 
Findings: In the joint marginalized random-effects model, the effect of time was significant on the rate of blood sedimentation (OR=1.56, 95% CI: 1.27-1.93). Moreover, time (OR=1.85, 95% CI: 1.55-2.21), smoking (OR=0.31, 95% CI: 0.12-0.82), and level of vitamin D (OR=1.0, 95% CI: 1.00-1.02) had a significant effect on sensitive joints. Confidence intervals, standard error, and amount of the AIC in the joint marginalized random-effects model were less than the univariable model.
 
Discussions & Conclusions: The results showed that the joint marginalized random-effect model could implement the mean of the marginal in the population as well as the correlation between the observations. Moreover, it was shown that the factors influencing the severity of the disease among the patients under study using the joint marginalized random-effects model included time, smoking, and vitamin D levels.
Keywords: Joint modeling, Longitudinal study, Marginalized framework, Random-effects, Severity of rheumatoid arthritis
Full-Text [PDF 909 kb]   (1580 Downloads)    
Type of Study: Research | Subject: biostatistics
Received: 2019/09/8 | Accepted: 2019/11/10 | Published: 2020/08/31
References
1. Firestein GS. Etiology and pathogenesis of rheumatoid arthritis.2 th ed. Sunders Publication. 2001;P. 921-66.
2. Koopman WJ. Moreland LW. Arthritis and allied conditions a textbook of rheumatology. 1 th ed. Lip Williams Wilkins Publication.2005;P.213-26.
3. Davatchi F. Pattern of rheumatic diseases in Asia pacific and the tropics. Ann Sci Meet Am Coll Rheumatol2005;2;201-9. doi.10.4103/0019-5359.103160
4. Klippel J, Dieppe P, Arnett F. Rheumatology. 2th ed. London Mosby Publication.1998;P.311-29.
5. Isenberg DA. Oxford textbook of rheumatology.1 th ed. Oxford Uni London Publication. 2004; P.172-8. doi. 10.1093/rheumatology/kem108
6. Imboden JB, Hellmann DB, Stone JH. Current rheumatology diagnosis and treatment. Curr Rheumatol Diagnos Treat 2007;3: 123-9.
7. West SG. Rheumatology secrets.1th ed. Else Health Sci Publication.2002:
8. Anderson D. Harrisons principles of internal medicine. Neurology2005;64: 1488-9.
9. Hastings DE, Evans JA. Rheumatoid wrist deformities and their relation to ulnar drift. J Bone Join SurgAm 1975;57: 930-4.
10. Akbariean M, Salehiabri E.Rheumatoid disease. 1th ed. Tehran Uni Publication. 2005;1:81-9.
11. Prevoo M. Modified disease activity scores that include twenty eight‐joint counts development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arth Rheum Off J Am Coll Rheumatol1995;38: 44-8.doi.10.1002/art.1780380107
12. Felson DT. The American college of rheumatology preliminary core set of disease activity measures for rheumatoid arthritis clinical trials. Arth Rheum Off J Am1993;36:729-40. doi.10.1002/art. 1780360601
13. Agresti A. A model for repeated measurements of a multivariate binary response. J Am Sta As1997;92: 315-21.doi. 10.1080/01621459.1997.10473629
14. Conaghan PG. Persistently moderate DAS-28 is not benign: loss of function occurs in early RA despite step-up DMARD therapy. Rheumatology 2010;49: 1894-9. doi.10.1093/rheumatology/keq178
15. Heagerty PJ. Marginally specified logistic normal models for longitudinal binary data. Biometrics 1999; 55: 688-98. doi.10.1111/j.0006-341x.1999.00688.x
16. Heagerty PJ, Zeger SL. Marginalized multilevel models and likelihood inference with comments and a rejoinder by the authors. Sta Sc 2000; 15: 1-26.
17. 17 YacoubY, Amine B, Laatiris A, Hajjajhassouni N. Health related quality of life in Moroccan patients with rheumatoid arthritis. Clin Rheumatol2012; 31: 1471-7. doi.10.1007/s10067-012-2037-x
18. Paco MJ, Welsingrobert B, Landewe M, Piet LCM, Riel V. The relationship between disease activity and radiologic progression in patients with rheumatoid arthritis a longitudinal analysis. Arth Rheum Offi J Am Coll Rheumatol2004; 50: 2082-93. doi.10.1002/art.20350
19. Praevoo M. Modified disease activity scores that include twenty eight joint counts. Arth Rheum 1995;38: 44-8. doi.10.1002/art.1780380107.
20. Saddamhussain MS, Tripathi V. Smoking under hypoxic conditions a potent environmental risk factor for inflammatory and autoimmune diseases. Militar Med Res 2018. 5: 1-14. doi.10.1186/s40779-018-0158-5
21. Uhlig T, Hagen K, Kvien T. Current tobacco smoking formal education and the risk of rheumatoid arthritis. J Rheumatol1999; 26: 47-54.doi.10.1136/ard. 59.8.631
22. Cranney ANN, Horsley T, Odonnell S, Weiler H, Puil L, Ooi D, et al. Effectiveness and safety of vitamin D in relation to bone health. Evid Rep Technol As2007; 1:22-7.
23. Mawer EB, Davies M. Vitamin D nutrition and bone disease in adults. Rev Endocr Metab Dis2001;2: 153-64.doi.10.1023/A:1010002710485
24. Esalatmanesh. [The relationship between serum vitamin d level and patient activity in patients with rheumatoid arthritis]. Feyz J Kashan Uni Med Sci 2011;14: 414-9. (Persian) doi.10.7860/JCDR/ 2017/24014. 9486
25. Turhanoglu AD. The relationship between vitamin D and disease activity and functional health status in rheumatoid arthritis. Rheumatol Int2011;31: 911-4. doi.10.1007/s00296-010-1393-6
26. Craig SM. Vitamin D status and its associations with disease activity and severity in African Americans with recent onset rheumatoid arthritis. J Rheumatol 2010. 37: 275-81.doi.10.3899/jrheum.090705
27. Oelzner P. Relationship between disease activity and serum levels of vitamin D metabolites and PTH in rheumatoid arthritis. Calcif Tis Int1998. 62: 193-8. doi.310.1007/s002239900416
28. Wolfe F, Hawley D. The longterm outcomes of rheumatoid arthritis. Work. J Rheumatol 1998; 25: 2107-8. doi.10.1136/ard.2003.011395
29. Moghimi N. [Relationship between platelet indices and severity of rheumatoid arthritis according to DAS28 criteria]. Sci J Kurdistan Uni Med Sci 2014;19: 1-8. (Persian)
30. Mobedi Z. [The effect of oral royal jelly on clinical disease activity index and morning stiffness in patients with rheumatoid arthritis a randomized double blind placebo controlled trial]. J Isfahan Med Sch 2013; 31: 1428-34. (Persian)

Ethics code: IR.USWR.REC.1397.045

XML   Persian Abstract   Print

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Volume 28, Issue 3 (7-2020) Back to browse issues page