Rheumatoid arthritis disease activity measures: American College of Rheumatology recommendations for use in clinical practice

Abstract

Objective Although the systematic measurement of disease activity facilitates clinical decision making in rheumatoid arthritis (RA), no recommendations currently exist on which measures should be applied in clinical practice in the US. The American College of Rheumatology (ACR) convened a Working Group (WG) to comprehensively evaluate the validity, feasibility, and acceptability of available RA disease activity measures and derive recommendations for their use in clinical practice. Methods The Rheumatoid Arthritis Clinical Disease Activity Measures Working Group conducted a systematic review of the literature to identify RA disease activity measures. Using exclusion criteria, input from an Expert Advisory Panel (EAP), and psychometric analysis, a list of potential measures was created. A survey was administered to rheumatologists soliciting input. The WG used these survey results in conjunction with the psychometric analyses to derive final recommendations. Results Systematic review of the literature resulted in identification of 63 RA disease activity measures. Application of exclusion criteria and ratings by the EAP narrowed the list to 14 measures for further evaluation. Practicing rheumatologists rated 9 of these 14 measures as most useful and feasible. From these 9 measures, the WG selected 6 with the best psychometric properties for inclusion in the final set of ACR-recommended RA disease activity measures. Conclusion We recommend the Clinical Disease Activity Index, Disease Activity Score with 28-joint counts (erythrocyte sedimentation rate or C-reactive protein), Patient Activity Scale (PAS), PAS-II, Routine Assessment of Patient Index Data with 3 measures, and Simplified Disease Activity Index because they are accurate reflections of disease activity; are sensitive to change; discriminate well between low, moderate, and high disease activity states; have remission criteria; and are feasible to perform in clinical settings.

Improving the Quality of Care of Patients With Rheumatic Disease Using Patient‐Centric Electronic Redesign Software

“…Incorporating such an approach requires that an agreed upon target be measured and acted upon reliably and routinely. There are multiple such targets, or disease activity measures, that are considered appropriate for use: Patient Activity Scale (PAS), PASII, RAPID-3, Simplified Disease Activity Index, CDAI, and DAS28 (8). However, most rheumatologists do not use a treatment to target approach, or even reliably measure disease activity or function, in clinical practice (8).…”

“…There are multiple such targets, or disease activity measures, that are considered appropriate for use: Patient Activity Scale (PAS), PASII, RAPID-3, Simplified Disease Activity Index, CDAI, and DAS28 (8). However, most rheumatologists do not use a treatment to target approach, or even reliably measure disease activity or function, in clinical practice (8). Rheumatologic disease assessment requires capture, calculation, and comparison of complex composite measures, and is therefore far more labor intensive than assessment of, for example, diabetes mellitus or hypertension, which have a single standard measure (laboratory test or blood pressure reading) (21).…”

“…Quality has been defined (3)(4)(5), treatment recommendations have been published (6,7), and validated quality measures exist that can inform us as to patient function and level of disease activity (8). A pervasive problem, however, is that the existing electronic health records (EHRs) are not optimized to provide the functionality needed to reliably operationalize care delivery for patients with rheumatic disease.…”

Effect of Anticitrullinated Protein Antibody Status on Response to Abatacept or Antitumor Necrosis Factor-α Therapy in Patients with Rheumatoid Arthritis: A US National Observational Study

“…As a strictly observational registry that reflects typical clinical practice, Corrona does not mandate that laboratory studies including serologic markers and acute-phase response reactants be collected. Among the data elements collected in the registry relevant to this study are modified (m)ACR20, mACR50, and mACR70 (mACR based on 2 out of 4 measures; does not include erythrocyte sedimentation rate or CRP) and modified (m)HAQ assessing physical function 9 . Data on demographics, insurance status, comorbid conditions, RA disease characteristics, and RA medications were available for > 98% of patients.…”

Documenting the Value of Care for Rheumatoid Arthritis, Analogous to Hypertension, Diabetes, and Hyperlipidemia: Is Control of Individual Patient Self-Report Measures of Global Estimate and Physical Function More Valuable Than Laboratory Tests, Radiographs, Indices, or Remission Criteria?

“…However, quantitative clinical data from a patient history in the form of a patient self-report questionnaire, and even from physical examination in the form of joint counts and physician global estimate, have not been incorporated by most clinical rheumatologists, at least in the United States 51 . Further, most training programs continue to neglect these quantitative clinical measures.…”