Outcome Assessments in Rheumatoid Arthritis
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Increasing evidence suggests low disease activity or remission is achievable in rheumatoid arthritis (RA). Using a treat to target strategy (T2T) has been shown to achieve these targets of remission or low disease activity in RA. In order to successfully treat to target, rheumatologists need reliable measures of disease activity to switch and/or escalate therapy to achieve or maintain therapeutic targets. Multiple disease-activity measures have been developed for both research and clinical practice. For clinical practice, the American College of Rheumatology (ACR) has recommended the PAS, PAS II, RAPID 3, CDAI, DAS 28, and SDAI for measuring disease activity in rheumatoid arthritis. Each of these measures has strengths and limitations, but they all accurately reflect disease activity, discriminate well between disease states, and are feasible to perform in the clinical setting. Implementation in the clinical setting can be optimized through leveraging technology and systems redesign. Tools such as web-based and smartphone applications have been developed to increase the ease with which these measures can be deployed. Disease-activity measurement in rheumatoid arthritis is included in the rheumatoid arthritis quality measures group in the Centers for Medicare and Medicaid Services’ incentive-based Physician Quality Reporting System.
KeywordsRheumatoid arthritis (RA) Disease activity measures Outcomes Treat to target strategy Patient-reported outcomes ACR American College of Rheumatology EULAR European league against Rheumatism Guidelines RAPID 3 PAS PAS II DAS DAS 28 SDAI CDAI Medical apps
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- 1.Firestein G. “Kelly’s textbook of rheumatology” chapter 66 and 67 Clinical features of rheumatoid arthritis and treatment of rheumatoid arthritis. 2009;1087–1139.Google Scholar
- 2.• Felson DT et al. American College of Rheumatology/European League against Rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials. Arthritis Rheum. 2011;63(3):573–86. The most current definition of remission in rheumatoid arthritis is described as a collaborative effort between both the ACR and EULAR.PubMedCrossRefGoogle Scholar
- 3.•• Singh JA et al. 2012 update of the 2008 American College of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis. Arthritis Care Res (Hoboken). 2012;64(5):625–39. An ACR update of the pharmocotherapy used to treat RA and pertinent treatment algorithms.CrossRefGoogle Scholar
- 9.Henkel G. Rheumatology’s divergent thinkers: OMERACT Selects Outcome Measures with an Egalitarian Process. The Rheumatologist. 2008;2008:20–1.Google Scholar
- 10.Outcome measures in rheumatology http://www.omeract.org/index.html.
- 15.PROMIS instruments http://www.nihpromis.org.
- 16.Curtis J. “How much patient reported outcomes improve among rheumatoid arthritis patients who have a clinical response to biologic therapy but have not attained low disease activity.” 2012. [Abstract #2101] Presented at ACR Annual Meeting, Washington DC, USA November 10–14, 2012.Google Scholar
- 17.Basch E “Toward patient-centered drug development in oncology.” N Eng J Med. 2013 Jul 3Google Scholar
- 19.Kazi S. ’Early experience with the ACR Clinical Registry (RCR). Arthritis Rheum. 2010;62 Suppl 10:993.Google Scholar
- 20.•• Anderson JK et al. Measures of rheumatoid arthritis disease activity: Patient (PtGA) and Provider (PrGA) Global Assessment of Disease Activity, Disease Activity Score (DAS) and Disease Activity Score with 28-Joint Counts (DAS28), Simplified Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI), Patient Activity Score (PAS) and Patient Activity Score-II (PASII), Routine Assessment of Patient Index Data (RAPID), Rheumatoid Arthritis Disease Activity Index (RADAI) and Rheumatoid Arthritis Disease Activity Index-5 (RADAI-5), Chronic Arthritis Systemic Index (CASI), Patient-Based Disease Activity Score With ESR (PDAS1) and Patient-Based Disease Activity Score without ESR (PDAS2), and Mean Overall Index for Rheumatoid Arthritis (MOI-RA). Arthritis Care Res (Hoboken). 2011;63 Suppl 11:S14–36. The most consolidated, evidence-based and ACR expert-reviewed description of each disease activity tool available until 2011.CrossRefGoogle Scholar
- 24.Aletaha D, Smolen JS. Remission of rheumatoid arthritis: should we care about definitions? Clin Exp Rheumatol. 2006;24(6 Suppl 43):S-45–51.Google Scholar
- 30.Pincus T et al. RAPID3 (Routine Assessment of Patient Index Data 3), a rheumatoid arthritis index without formal joint counts for routine care: proposed severity categories compared to disease activity score and clinical disease activity index categories. J Rheumatol. 2008;35(11):2136–47.PubMedCrossRefGoogle Scholar
- 32.Yazdany J et al. Choosing wisely: the American College of Rheumatology's Top 5 list of things physicians and patients should question. Arthritis Care Res (Hoboken). 2013;65(3):329–39.Google Scholar
- 35.Collins T. “Tech Talk: apps put more rheumatology information at fingertips” The Rheumatologist. 2012. June.Google Scholar
- 36.Pincus T. “The Science of MDHAQ/RAPID3 Scores. Do patient self-reports provide valid data for evidence-based care in rheumatology practice?” The Rheumatologist. 2011. Dec.Google Scholar