Assessment of control of rheumatoid arthritis disease activity

Salomon-Escoto, Karen; Gravallese, Ellen M.; Kay, Jonathan

doi:10.1016/j.berh.2011.10.007

Cited by 21 publications

(17 citation statements)

References 37 publications

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“…Introduced in 1995 [8], the DAS28 has a cut-off value of <2.6 defining RA remission [9] but does not include a disability assessment. Moreover, real-life practice clearly shows that multiple joints can remain swollen or tender, and that pain can persist even when patients meet the remission cut-off score [10]. It is interesting to note that a recent large-scale observational study found disparities between the reduction in disease activity as expressed by DAS28 scores and the progression of disability [11].…”

Section: Introductionmentioning

confidence: 99%

Effects of Anti-TNF Alpha Drugs on Disability in Patients with Rheumatoid Arthritis: Long-Term Real-Life Data from the Lorhen Registry

Filippini

Bazzani

Atzeni

et al. 2014

BioMed Research International

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This study involving 1033 patients with RA confirms the effectiveness of etanercept, adalimumab, and infliximab in reducing RA-related disability even in patients with a history of highly active and longstanding RA. Moreover, we found that the improvement in disability was biphasic, with a marked improvement during the first year of anti-TNF therapy, followed by slower but significant recovery over the subsequent four years.

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Section: Introductionmentioning

confidence: 99%

Effects of Anti-TNF Alpha Drugs on Disability in Patients with Rheumatoid Arthritis: Long-Term Real-Life Data from the Lorhen Registry

Filippini

Bazzani

Atzeni

et al. 2014

BioMed Research International

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“…In the BeST study, there was an association between patients who received more aggressive treatment strategies and improvements in functional outcomes and radiographic progression [30]. However in current clinical practice, documentation of QMs may be poor, our tools to precisely review charts to collect QM data may not be optimal, and there can be a disconnect between clinical remission and radiographic progression—erosions can still develop in patients who are in remission [31]. Thus at present, disease activity assessment may be one of the most optimal outcome measures for RA.…”

Section: Discussionmentioning

confidence: 99%

Rheumatoid arthritis quality measures and radiographic progression

Desai¹,

Liu²,

Tory³

et al. 2014

Seminars in Arthritis and Rheumatism

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Objective Documentation of quality measures (QMs) in rheumatoid arthritis (RA) is used as a surrogate for measure of quality of care, but the association of this documentation with radiographic outcomes is uncertain. We examined documentation of RA QMs, for disease activity and functional status and the association with radiographic outcomes. Methods Data were analyzed for 438 RA patients in a longitudinal cohort with complete data on van der Heijde-modified Total Sharp Score (TSS). All rheumatologist (N = 18) notes in the electronic medical record during a 24-month period were reviewed for RA QMs. Any mention of disease activity categorized as low, moderate, or high was considered documentation of the QM for disease activity. Functional status QM documentation included any mention of the impact of RA on function. Change in TSS was quantified with progression defined as ≥1 unit per year. We compared percent of visits with an RA QM documented and mean change in TSS. Results The mean age in the cohort was 56.9 years, disease duration was 10.8 years, baseline DAS28 score was 3.8 (±1.6), 67.7% were seropositive, and 33.9% used a biologic DMARD. Radiographic progression was observed in 28.5%. Disease activity was documented for 29.0% of patient visits and functional status in 74.7%; neither had any significant relationship to mean TSS change (both P > 0.10). Conclusion The documentation of RA QMs was infrequent and not associated with radiographic outcomes over 24 months.

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“…Various definitions of disease activity have thus far been proposed, including ACR criteria, disease activity score (DAS), DAS28, simplified disease activity index (SDAI) and clinical disease activity index (CDAI). The core set for ACR response criteria include seven clinical end points: swollen joint count, tender joint count, physician's assessment of disease activity, patient's assessment of disease activity, patient's assessment of pain, and patient's assessment of physical function, and levels of an acute-phase reactant (either the CRP level or the ESR) [38]. An ACR20 response is defined as at least 20% improvement in both the tender joint count and the swollen joint count and at least 20% improvement in three of the five other core set measures.…”

Section: Evaluation Of Disease Activitymentioning

confidence: 99%

“…Although DAS < 1.6 was reported to correlate well with ACR remission criteria, and DAS28 < 2.6 with DAS < 1.6 [40-42], the implication of omitting foot and ankle joint in DAS28 is not well known. In our previous study, significant number of patients in clinical remission defined by DAS28 < 2.6 had foot metatarsophalangeal (MTP) and ankle involvement with some patients even showing isolated foot or MTP joint involvement without evidence of disease activity in other joints [38]. Among those who had radiograph available for examination, 30% showed radiographic joint damage at the time of clinical remission.…”

Section: Evaluation Of Disease Activitymentioning

confidence: 99%

Recent Paradigm Shifts in the Diagnosis and Treatment of Rheumatoid Arthritis

Jung

Kim

2012

Korean J Intern Med

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Rheumatoid arthritis (RA) is a progressive inflammatory disease with severe symptoms of pain and stiffness. Chronic persistent inflammation of RA often leads to joint destruction, deformity and limitation of function, which ultimately results in significant deterioration of quality of life (QoL). RA is characterized pathogenetically by immunologically driven, chronic synovitis, and production of autoantibodies, such as rheumatoid factor and anti-cyclic citrullinated peptide antibodies. Although the cause of RA is yet unknown, advances in the molecular biology led to in-depth understanding of its pathogenesis, and have fostered the recent development of novel treatments. The last decade has seen the dramatic change in the landscape of RA treatment with more aggressive therapy early in the disease course and with treatment guided by a structured assessment of disease activity, with the ultimate goal of reaching remission. In addition, prevention and control of joint damage and improvement in QoL are important goals. To achieve these goals, a multidisciplinary approach to reduce disease activity with disease modifying antirheumatic drugs and biological therapy is needed. We also need to find ways to identify those patients who are at risk for more rapid disease progression who would benefit from intensive therapy early in the course of disease.

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Assessment of control of rheumatoid arthritis disease activity

Cited by 21 publications

References 37 publications

Effects of Anti-TNF Alpha Drugs on Disability in Patients with Rheumatoid Arthritis: Long-Term Real-Life Data from the Lorhen Registry

Effects of Anti-TNF Alpha Drugs on Disability in Patients with Rheumatoid Arthritis: Long-Term Real-Life Data from the Lorhen Registry

Rheumatoid arthritis quality measures and radiographic progression

Recent Paradigm Shifts in the Diagnosis and Treatment of Rheumatoid Arthritis

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