2019 Update of the American College of Rheumatology Recommended Rheumatoid Arthritis Disease Activity Measures

Abstract

Objective To provide updated American College of Rheumatology (ACR) recommendations on rheumatoid arthritis (RA) disease activity measurements to facilitate a treat‐to‐target approach in routine clinical care. Methods A working group conducted a systematic literature review from the time of the prior ACR recommendations literature search. Properties of disease activity measures were abstracted, and study quality was assessed using the Consensus‐Based Standards for the selection of Health Measurement Instruments 4‐point scoring method, allowing for overall level of evidence assessment. Measures that fulfilled a minimum standard were identified, and through a modified Delphi process preferred measures were selected for regular use in most clinic settings. Results The search identified 5,199 articles, of which 110 were included in the review. This search identified 46 RA disease activity measures that contained patient, provider, laboratory, and/or imaging data. Descriptions of the measures, properties, study quality, level of evidence, and feasibility were abstracted and scored. Following a modified Delphi process, 11 measures fulfilled a minimum standard for regular use in most clinic settings, and 5 measures were recommended: the Disease Activity Score in 28 Joints with Erythrocyte Sedimentation Rate or C‐Reactive Protein Level, Clinical Disease Activity Index, Simplified Disease Activity Index, Routine Assessment of Patient Index Data 3, and Patient Activity Scale‐II. Conclusion We have updated prior ACR recommendations for preferred RA disease activity measures, identifying 11 measures that met a minimum standard for regular use and 5 measures that were preferred for regular use in most clinic settings.

2019 American College of Rheumatology Recommended Patient‐Reported Functional Status Assessment Measures in Rheumatoid Arthritis

“…The ACR Quality Measures Subcommittee approved these 2 recommendations with only 1 modification, which was the additional recommendation of the MDHAQ. The MDHAQ was included in the measures for preferred use based upon Delphi rating, feasibility, current use, and strength of its inclusion in the prior and concurrent ACR RA disease activity measure recommendations within the Routine Assessment of Patient Index Data 3 (RAPID3), considerations beyond this current work that focused solely on function.…”

2019 update of the American College of Rheumatology– recommended rheumatoid arthritis disease activity measures: comment on the article by England et al

“…I read the article by England et al , recently published in Arthritis Care & Research , with great interest; it discusses the appropriate metrics to be used by practicing rheumatologists employing a treat‐to‐target approach. The article is comprehensive and well written.…”

What further data are needed to value the Multi‐Biomarker Disease Activity score for measuring rheumatoid arthritis disease activity: comment on the article by Johnson et al

“…Recently, the ACR updated its recommended RA disease activity measures for regular clinical use , following a systematic literature review from the time of the prior 2012 recommendations and after a modified Delphi process. The 3‐round Delphi method yielded final recommendations in rank order: CDAI, SDAI, RAPID3, and the DAS28 with either erythrocyte sedimentation rate or CRP level . The MBDA score or Vectra DA was not recommended but fulfilled a minimum standard for regular use.…”

“…Cost was not considered in selection or recommendation of any measures in the updated ACR recommendations nor in the Johnson et al study. However, Johnson et al cited a retrospective decision analysis study of clinical management and cost using MBDA, supported by Crescendo Biosciences, without comparison to other RA disease activity measures .…”

“…Presently, my view is that Vectra DA cannot be supported over the other ACR‐recommended measures of RA disease activity for routine use in clinical practice , given its continued lack of scientifically objective, prospective studies to elucidate clinical utility and construct validity, as to how well it actually achieves its claims . Further, biomarker‐independent funding support will also be needed to achieve the highest degree of scientific objectivity in future prospective cost‐effective evaluation.…”