Glossary of terms in lay language, in alphabetical order
| Terms | Explanation in lay language | No* |
|---|---|---|
| Adjustment of drug treatment | A change to the drug treatment has to be made. This is not always necessarily a change in drug. For patients who have not achieved the primary target of remission but show significant improvement over the last 3 months, dose adaptation or continuation for several weeks instead of change of drug(s) may be sufficient. The kind of adjustment depends on the applied strategy and individual response of the patient. | D, 4 |
| Clinical remission | Clinical remission is based on the complaints by the patient, examination of the joints and results of laboratory tests. This can be done by the rheumatologist using a variety of instruments that measure disease activity (see table 3). When the score is below a set value, the patient is in a state of remission. Clinical remission does not incorporate radiographic, MRI, ultrasound or other imaging outcomes. | 1, 2 |
| Comorbidity | The existence of two or more (chronic) diseases in one person at the same time—for example, a patient with RA and diabetes mellitus or RA and hypertension | 9 |
| Composite measure | Measurement instrument that combines different aspects of the disease into a single numerical value. Examples of composite measures for disease activity in RA are: Clinical Disease Activity Index, Simplified Disease Activity Index, Disease Activity Score and Disease Activity Score 28 joint count. | 6, 7, 8 |
| Disease activity | Signs and symptoms caused by inflammation owing to RA. Rheumatologists use cut-off points to delineate different levels of disease activity. They often distinguish between four states of disease activity: high, moderate, low or remission. A common definition of these four states is currently not available; the definition depends on the instrument that is used (see table 3). | D, 2, 3, 5, 6 |
| Functional impairment | The impact of the disease on performing tasks in daily life | 7 |
| Health-related Quality of Life | Health-related quality of life is key in this statement. Quality of life is determined by a variety of individual and social factors. Health-related quality of life refers directly to the impact of the disease on daily life. It is not limited to the medical encounters in the clinic. It includes the impact of the disease on psychological health, work participation, family life, social relationships and leisure. | B |
| Inflammation | Inflammation is the basis of the disease process in RA. It is caused by immune system cells and their products (cytokines), and leads directly to signs and symptoms, such as joint swelling, pain and stiffness. It also results in joint damage and limited function. By stopping the inflammation, damage and disability can be reduced or even avoided. | C, 2 |
| Measurement; measurement score | The assessment of a particular health-related factor by using the most appropriate instrument (eg, test or questionnaire) | 5, 6, 7, 9 |
| Normal function | Normalisation of function is trying to return to normality: the state where a person was before the disease started | 7 |
| Outcome | The effect (end result) of the disease process on the patient or the effect of a treatment on a patient, which may be measured in different ways. Patient-related outcomes are based on the experience or opinion by the patient, and include, for example, pain, fatigue and physical function. Objective measures (outcomes) are independent of the opinion of the patient—for example, radiological joint damage (x rays) or blood tests (signs of inflammation such as sedimentation rate or C reactive protein). The term “optimising outcomes” means trying to achieve the “best end results.” | D |
| Patient factors | Patient factors relates to personal preferences and characteristics such as occupation, age or gender | 9 |
| Remission | A state of disease activity without any significant signs of inflammation | 1, 2, 3, 4 |
| Shared decision-making | The process by which the physician and the patient take a decision together, based on a dialogue about the preferences of the patient and the knowledge (“evidence”) of the physician. A condition for shared decision-making is an equal partnership in the patient–doctor relation. | A |
| Significant | “Significant” might be translated into other languages with synonyms such as important, serious, most, crucial or relevant. “Significant” is a relative term and often causes discussion, depending on the context and the individual perspective. In research, an outcome is statistically significant if it is unlikely that the outcome has occurred by chance (eg, a significant change in pain on a new drug). Clinical significance refers to an individual appreciation of an improvement in the real world: is an improvement really important from the perspective of the patient? | 2 |
| Signs | Signs are the manifestations that can be observed by physical examination, such as the number of swollen joints | 2 |
| Social participation | The ability to contribute to society or to enjoy social life. Functional limitations can seriously restrict chances of participation in daily-life activities. | B, 7 |
| Strategy | A predefined way by which the clinician and the patient try to achieve the treatment target | D, 10 |
| Structural damage | The destruction of bones and joints, as can be detected using imaging techniques such as x rays, MRI or sonography. This is caused by inflammation and is largely irreversible. | B, 7 |
| Sustained remission | A state of remission that is maintained during a longer period of time—for example, more than 6 months | 5 |
| Symptoms | Symptoms are manifestations of the disease as they are felt or experienced by the patient like fatigue, pain or stiffness | 2 |
| Target | Ultimate goal; the final outcome you want to achieve by treating RA | passim |
| Validated measurement instrument | An instrument (method, questionnaire, test) that has been scientifically proven to measure what it supposes to measure in a particular disease | 6 |
↵* The third column indicates the treat-to-target statements where the original term is used. The letters A–D refer to the overarching principles, and the ciphers 1–10 refer to the recommendations.
RA, rheumatoid arthritis.