In this issue of the Annals of the Rheumatic Diseases, Van Hulst and colleagues1 have published a paper on the development of quality indicators for monitoring of the disease course in rheumatoid arthritis (RA). By focusing on the monitoring of the disease course, Van Hulst et al1 have made an important and relevant contribution to the improvement of the quality of care for RA patients. Over the past decades, it has been consistently demonstrated that intensive monitoring of the disease course and the subsequent adaptation of drug treatment have significant positive effects on disease activity, radiological damage, activities and participation and overall quality of life.2 3 4 5 6 7 8 9 10 11 Despite ample evidence from the literature and the availability of various guidelines, recommendations and quality indicators addressing the monitoring of the disease course,12 13 14 15 16 17 several audits of rheumatologists’ clinical practice have demonstrated a substantial lack of compliance with recommendations on disease monitoring.18 19 The set of quality indicators presented by van Hulst et al1 gives rheumatologists practical guidance on how to implement the available evidence on disease monitoring into their practices.

The quality indicator “industry” is currently booming, in rheumatology as in health care in general, as this is seen as an important strategy to improve the quality of care. Quality indicators measure, as defined by the US Institute of Medicine, “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge”.20 21 Quality indicators are commonly derived from already available sets of guidelines or recommendations, and/or literature searches and expert opinion, according to a systematic approach.22 23 It should be noted that, in contrast to most guidelines or recommendations, …