Table 2

Glossary of terms in lay language, in alphabetical order

TermsExplanation in lay languageNo*
Adjustment of drug treatmentA 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 remissionClinical 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
ComorbidityThe 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
Composite measureMeasurement 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 activitySigns 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 impairmentThe impact of the disease on performing tasks in daily life7
Health-related Quality of LifeHealth-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.
InflammationInflammation 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 scoreThe assessment of a particular health-related factor by using the most appropriate instrument (eg, test or questionnaire)5, 6, 7, 9
Normal functionNormalisation of function is trying to return to normality: the state where a person was before the disease started7
OutcomeThe 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.”
Patient factorsPatient factors relates to personal preferences and characteristics such as occupation, age or gender9
RemissionA state of disease activity without any significant signs of inflammation1, 2, 3, 4
Shared decision-makingThe 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.
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?
SignsSigns are the manifestations that can be observed by physical examination, such as the number of swollen joints2
Social participationThe ability to contribute to society or to enjoy social life. Functional limitations can seriously restrict chances of
participation in daily-life activities.
B, 7
StrategyA predefined way by which the clinician and the patient try to achieve the treatment targetD, 10
Structural damageThe 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 remissionA state of remission that is maintained during a longer period of time—for example, more than 6 months5
SymptomsSymptoms are manifestations of the disease as they are felt or experienced by the patient like fatigue, pain or stiffness2
TargetUltimate goal; the final outcome you want to achieve by treating RApassim
Validated measurement instrumentAn instrument (method, questionnaire, test) that has been scientifically proven to measure what it supposes to
measure in a particular disease
  • * 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.