The comparative responsiveness of Hospital Universitario Princesa Index and other composite indices for assessing rheumatoid arthritis activity

Isidoro Gonzalez-Alvaro*, Isabel Castrejon, Loreto Carmona, M. Dougados, T. Huizinga, M. Abu Shakra, A. Alberts, M. Alperi Lopez, H. Amital, M. Aringer, S. Aslanidis, F. Berenbaum, H. Bijlsma, F. J. Blanco Garcia, H. Bliddal, M. Borofsky, O. Brocq, S. Buldakov, F. Cantini, L. Carreno PerezW. Chahade, R. Ciconelli, C. Codreanu, S. R. Dahlqvist, N. Damjanov, A. Diamantopoulos, L. Dimdina, A. Dimic, A. Dorokhov, A. Dubikov, G. Fadienko, N. Fano, G. Ferreira, A. Gabrielli, K. Gaffney, P. Gaudin, D. M. Gerlag, R. Gerli, C. R. Goncalves, M. S. Hansen, P. Hanvivadhanakul, C. Hoili, A. Hou, J. Hunter, T. Ilic, R. Ionescu, J. Kaine, N. Kakurina, J. Van Laar, D. Vosse, ACT-RAY Study Group, PROAR Study Group, EMECAR Study Group

*Corresponding author for this work

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To evaluate the responsiveness in terms of correlation of the Hospital Universitario La Princesa Index (HUPI) comparatively to the traditional composite indices used to assess disease activity in rheumatoid arthritis (RA), and to compare the performance of HUPI-based response criteria with that of the EULAR response criteria.


Secondary data analysis from the following studies: ACT-RAY (clinical trial), PROAR (early RA cohort) and EMECAR (pre-biologic era long term RA cohort). Responsiveness was evaluated by: 1) comparing change from baseline (Delta) of HUPI with Delta in other scores by calculating correlation coefficients; 2) calculating standardised effect sizes. The accuracy of response by HUPI and by EULAR criteria was analyzed using linear regressions in which the dependent variable was change in global assessment by physician (Delta GDA-Phy).


Delta HUPI correlation with change in all other indices ranged from 0.387 to 0.791); HUPI's standardized effect size was larger than those from the other indices in each database used. In ACT-RAY, depending on visit, between 65 and 80% of patients were equally classified by HUPI and EULAR response criteria. However, HUPI criteria were slightly more stringent, with higher percentage of patients classified as non-responder, especially at early visits. HUPI response criteria showed a slightly higher accuracy than EULAR response criteria when using Delta GDA-Phy as gold standard.


HUPI shows good responsiveness in terms of correlation in each studied scenario (clinical trial, early RA cohort, and established RA cohort). Response criteria by HUPI seem more stringent than EULAR's.

Original languageEnglish
Article number0214717
Number of pages19
Issue number4
Publication statusPublished - 10 Apr 2019



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