Mallya and Mace developed an index for assessing disease activity in patients with rheumatoid arthritis. This can be used to monitor a patient over time and to evaluate the response to therapeutic interventions. The authors are from Lewisham Hospital in London.
Parameters:
(1) morning stiffness (MS)
(2) visual analogue pain scale (PS) in cm, measured along a 10 cm scale
(3) grip strength (GS)
(4) Ritchie articular index (AI)
(5) hemoglobin (Hb)
(6) erythrocyte sedimentation rate (ESR)
where:
• Grip strength was measured using an apparatus consisting of a mercury manometer attached to a rubber cuff. This cuff was squeezed in each hand three times, and then an average value for the 6 readings was taken. Other instruments are available for measuring grip strength.
|
Parameter |
Finding |
Grade |
|
morning stiffness |
< 10 minutes |
1 |
|
|
10 – 30 minutes |
2 |
|
|
31 – 120 minutes |
3 |
|
|
> 120 minutes |
4 |
|
pain scale |
0 – 2.4 cm |
1 |
|
|
2.5 – 4.4 cm |
2 |
|
|
4.5 – 6.4 cm |
3 |
|
|
6.5 – 10.0 cm |
4 |
|
grip strength |
> 200 mm Hg |
1 |
|
|
50 – 200 mm Hg |
2 |
|
|
21 – 49 mm Hg |
3 |
|
|
<= 20 mm Hg |
4 |
|
articular index |
0 points |
1 |
|
|
1 – 7 points |
2 |
|
|
8 – 17 points |
3 |
|
|
>= 18 points |
4 |
|
hemoglobin |
>= 14.1 g/dL |
1 |
|
|
13 – 14 g/dL |
2 |
|
|
10 – 12.9 g/dL |
3 |
|
|
<= 9.9 g/dL |
4 |
|
ESR |
0 – 20 mm/h |
1 |
|
|
21 – 45 mm/h |
2 |
|
|
46 – 80 mm/h |
3 |
|
|
>= 81 mm/h |
4 |
total score =
= SUM(points for all 6 parameters)
index of disease activity = IDA =
= (total score) / 6
|
IDA |
Mean Disease Activity Grade (MDAG) |
|
1.0 – 1.4 |
Grade I |
|
1.5 – 2.4 |
Grade II |
|
2.5 – 3.4 |
Grade III |
|
3.5 – 4.0 |
Grade IV |
Purpose: To evaluate disease activity in a patient with rheumatoid arthritis using the index of Mallya and Mace.
Specialty: Immunology/Rheumatology
Objective: criteria for diagnosis, severity, prognosis, stage, response to therapy, disease progression
ICD-10: M05, M06,
