A working group convened by the American College of Rheumatology (ACR)
has evaluated more than 60 disease activity measures for rheumatoid
arthritis (RA). The group narrowed the number of RA disease activity
measures and the recommended six for use in U.S. clinical practice are
detailed in Arthritis
Care & Research, a journal published by Wiley-Blackwell on
behalf of the ACR.
RA is a systemic inflammatory disease, affecting more than 1 million
Americans according to ACR estimates. Medical evidence has shown
significant improvement in RA treatment over the last two decades,
making disease remission possible for many patients. While many health
care stakeholders advocate standardized assessments for RA disease
activity, uniform measures of RA activity are not currently used by U.S.
rheumatologists.
To address this important issue, the RA Clinical Disease Activity
Measures Working Group systematically reviewed medical literature to
identify disease activity measures for RA. The group surveyed
rheumatologists for input and used this feedback along with psychometric
analysis to determine recommendations for RA disease activity
assessments.
"Our goal was to determine which RA disease activity measures could
accurately distinguish the various levels of RA activity, and would also
be reasonable to implement in clinical practice,” explains Salahuddin
Kazi, M.D., with Dallas VA Medical Center in Texas and one of the lead
researchers involved with the working group. The group identified 63 RA
disease activity measures, narrowing that down to 14 measures for
further evaluation by practicing rheumatologists.
Feedback from the rheumatologists determined that 9 measures would be
most useful and feasible in a clinical setting. The working group then
selected 6 disease activity measures based on their reliability,
validity and responsiveness. The ACR-approved recommendations for RA
disease activity measures include:
-
Clinical Disease Activity Index (CDAI)
-
Disease Activity Score with 28-joint counts (erythrocyte sedimentation
rate or C-reactive protein) (DAS-28)
-
Patient Activity Scale (PAS)
-
PAS-II
-
Routine Assessment of Patient Index Data with 3 measures (RAPID 3)
-
Simplified Disease Activity Index (SDAI)
In a related article, “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,” Singh et al. include the RA disease activity measures (Table
3) to guide clinicians in selecting the appropriate treatment options
for their patients (see release below). “Rheumatologists are tasked with
treating to target, and one or more of these disease activity measures
will help determine the level of RA disease activity in the patient,”
said Dr. Kazi.
“The measures recommended to determine RA disease activity are sensitive
to change, can discriminate between low, moderate, and high disease
activity states, include remission criteria, and are feasible to perform
in a clinical setting,” concludes Dr. Kazi. “Incorporating standardized
disease activity measures will facilitate adherence to the ACR
guidelines for treating RA and aid clinicians in providing quality care
to their patients with RA.”
