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Outcome Assessments in Rheumatoid Arthritis

  • RHEUMATOID ARTHRITIS (LW MORELAND, SECTION EDITOR)
  • Published:
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Abstract

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.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  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.

  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.

    Article  PubMed  Google 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.

    Article  CAS  Google Scholar 

  4. • Smolen JS et al. Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis. 2010;69(4):631–7. Evidence-based recommendations for a treat to target strategy.

    Article  PubMed  Google Scholar 

  5. Grigor C et al. Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): a single-blind randomised controlled trial. Lancet. 2004;364(9430):263–9.

    Article  PubMed  Google Scholar 

  6. Goekoop-Ruiterman YP et al. DAS-driven therapy versus routine care in patients with recent-onset active rheumatoid arthritis. Ann Rheum Dis. 2010;69(1):65–9.

    Article  PubMed  CAS  Google Scholar 

  7. Curtis JR et al. Predicting low disease activity and remission using early treatment response to antitumour necrosis factor therapy in patients with rheumatoid arthritis: exploratory analyses from the TEMPO trial. Ann Rheum Dis. 2012;71(2):206–12.

    Article  PubMed  CAS  Google Scholar 

  8. •• Anderson J et al. Rheumatoid arthritis disease activity measures: American College of Rheumatology recommendations for use in clinical practice. Arthritis Care Res (Hoboken). 2012;64(5):640–7. A description of the six disease-activity tools endorsed by the ACR.

    Article  Google 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.

  11. Lansbury J. Quantitation of the activity of rheumatoid arthritis. 5. A method for summation of the systemic indices of rheumatoid activity. Am J Med Sci. 1956;232(3):300–10.

    Article  PubMed  CAS  Google Scholar 

  12. Boers M et al. Randomised comparison of combined step-down prednisolone, methotrexate and sulphasalazine with sulphasalazine alone in early rheumatoid arthritis. Lancet. 1997;350(9074):309–18.

    Article  PubMed  CAS  Google Scholar 

  13. Verhoeven AC et al. Responsiveness of the core set, response criteria, and utilities in early rheumatoid arthritis. Ann Rheum Dis. 2000;59(12):966–74.

    Article  PubMed  CAS  Google Scholar 

  14. Felson DT et al. The American College of Rheumatology preliminary core set of disease activity measures for rheumatoid arthritis clinical trials. The Committee on Outcome Measures in Rheumatoid Arthritis Clinical Trials. Arthritis Rheum. 1993;36(6):729–40.

    Article  PubMed  CAS  Google Scholar 

  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.

  17. Basch E “Toward patient-centered drug development in oncology.” N Eng J Med. 2013 Jul 3

  18. Bruce B, Fries JF. The Health Assessment Questionnaire (HAQ). Clin Exp Rheumatol. 2005;23(5 Suppl 39):S14–8.

    PubMed  CAS  Google 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.

    Article  Google Scholar 

  21. Inoue E et al. Comparison of Disease Activity Score (DAS)28- erythrocyte sedimentation rate and DAS28- C-reactive protein threshold values. Ann Rheum Dis. 2007;66(3):407–9.

    Article  PubMed  CAS  Google Scholar 

  22. Landewe R et al. Twenty-eight-joint counts invalidate the DAS28 remission definition owing to the omission of the lower extremity joints: a comparison with the original DAS remission. Ann Rheum Dis. 2006;65(5):637–41.

    Article  PubMed  CAS  Google Scholar 

  23. Smolen JS et al. A simplified disease activity index for rheumatoid arthritis for use in clinical practice. Rheumatology (Oxford). 2003;42(2):244–57.

    Article  CAS  Google 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 

  25. Balsa A et al. Superiority of SDAI over DAS-28 in assessment of remission in rheumatoid arthritis patients using power Doppler ultrasonography as a gold standard. Rheumatology (Oxford). 2010;49(4):683–90.

    Article  Google Scholar 

  26. Aletaha D et al. Acute phase reactants add little to composite disease activity indices for rheumatoid arthritis: validation of a clinical activity score. Arthritis Res Ther. 2005;7(4):R796–806.

    Article  PubMed  CAS  Google Scholar 

  27. Parekh K, Taylor WJ. The patient activity scale-II is a generic indicator of active disease in patients with rheumatic disorders. J Rheumatol. 2010;37(9):1932–4.

    Article  PubMed  Google Scholar 

  28. Felson DT et al. The American College of Rheumatology preliminary core set of disease activity measures for rheumatoid arthritis clinical trials. The Committee on Outcome Measures in Rheumatoid Arthritis Clinical Trials. Arthritis Rheum. 1993;36(6):729–40.

    Article  PubMed  CAS  Google Scholar 

  29. Wolfe F et al. A composite disease activity scale for clinical practice, observational studies, and clinical trials: the patient activity scale (PAS/PAS-II). J Rheumatol. 2005;32(12):2410–5.

    PubMed  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.

    Article  PubMed  Google Scholar 

  31. Callahan LF et al. Self-report questionnaires in five rheumatic diseases: comparisons of health status constructs and associations with formal education level. Arthritis Care Res. 1989;2(4):122–31.

    Article  PubMed  CAS  Google 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 

  33. Sobo EJ et al. Behind the scenes in health care improvement: the complex structures and emergent strategies of Implementation Science. Soc Sci Med. 2008;67(10):1530–40.

    Article  PubMed  Google Scholar 

  34. Robbins J et al. How high-performance work systems drive health care value: an examination of leading process improvement strategies. Qual Manag Health Care. 2012;21(3):188–202.

    Article  PubMed  Google Scholar 

  35. Collins T. “Tech Talk: apps put more rheumatology information at fingertips” The Rheumatologist. 2012. June.

  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.

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Conflict of Interest

Katarzyna Gilek, Kara Prescott, and Salahuddin Kazi declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Division of Rheumatic Diseases, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8884, USA

    Katarzyna Gilek-Seibert, Kara Prescott & Salahuddin Kazi

Authors
  1. Katarzyna Gilek-Seibert
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  2. Kara Prescott
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  3. Salahuddin Kazi
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Correspondence to Katarzyna Gilek-Seibert.

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This article is part of the Topical Collection on Rheumatoid Arthritis

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Gilek-Seibert, K., Prescott, K. & Kazi, S. Outcome Assessments in Rheumatoid Arthritis. Curr Rheumatol Rep 15, 370 (2013). https://doi.org/10.1007/s11926-013-0370-y

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