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Monitoring disease activity of rheumatoid arthritis in clinical practice: contributions from clinical trials

Nature Clinical Practice Rheumatology volume 2, pages 611–618 (2006)Cite this article

Abstract

Rheumatoid arthritis is a heterogeneous and progressive autoimmune disease, and patients with this condition show varied responses to treatment. Practical, reliable, individually tailored measures of disease activity and treatment responses are needed. Outcome measures used in randomized, controlled trials, including American College of Rheumatology response criteria and Disease Activity Scores, identify when treatment should be initiated or changed, but can be time consuming and impractical in daily practice. Simplified disease activity indices, abbreviated joint counts and patient-report questionnaires are more-convenient ways to assess therapeutic responses in the clinic. Patient-reported measures of physical function, pain and global disease activity best differentiate the results of active treatment from those of placebo treatment in randomized, controlled trials. Improvements in physical function closely reflect changes in health-related quality of life. Recent trials have demonstrated limited correlations between clinical responses and radiographically demonstrated responses; both should be assessed on a regular basis. It is recommended that three domains be assessed in the clinic for therapeutic responses: patient-reported measures of physical function and/or global disease activity; physician assessment of disease activity; and imaging of the hands and/or feet on a biannual basis. Problematic joints and cervical spine involvement should be followed as clinically indicated. Measures of improvement for individually relevant physical activities need to be defined for each patient.

Key Points

  • Randomized, controlled trials can significantly inform clinical practice

  • The American College of Rheumatology response criteria were developed to distinguish the results of active treatment from those of placebo treatment in randomized, controlled trials, and have facilitated the approval of six new disease-modifying antirheumatic drugs

  • The Disease Activity Score measures current disease activity, as well as improvements

  • Simplified disease-activity indices, which are the sum of the components of the Disease Activity Score have been developed for routine clinical use

  • Patient-reported measures of physical function, pain and global disease activity are important assessments of response, and best differentiate changes due to active treatment from changes due to placebo treatment in randomized, controlled trials.

  • The Health Assessment Questionnaire is a simple, effective, and accurate measure of physical function

  • Regular X-rays of the hands and feet provide an objective measure of progression of joint damage; recent randomized, controlled trials have demonstrated a partial correlation between clinical and radiographically assessed responses

  • To monitor disease activity in clinical practice, three domains should be assessed: patient-reported physical function or global disease activity; physician assessment of disease activity; and imaging of the hands on a regular basis, including evaluation of problematic joints

  • Measures of outcomes that are relevant to the individual patient need to be incorporated in current methods

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Author information

Authors and Affiliations

  1. Stanford University School of Medicine,

    Ernesto Zatarain & Vibeke Strand

  2. Palo Alto Veterans Administration Hospital, Palo Alto

    Ernesto Zatarain & Vibeke Strand

  3. Stanford University School of Medicine, Palo Alto, CA, USA

    Ernesto Zatarain & Vibeke Strand

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  1. Ernesto Zatarain
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Correspondence to Ernesto Zatarain.

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Zatarain, E., Strand, V. Monitoring disease activity of rheumatoid arthritis in clinical practice: contributions from clinical trials. Nat Rev Rheumatol 2, 611–618 (2006). https://doi.org/10.1038/ncprheum0246

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