A variety of measures are available that can be used to assess various aspects of the disease and help to inform treatment decisions.2
Different clinical outcome measures can be employed depending on informational needs and patient context.1,3
Composite disease activity measures can reflect multiple aspects of RA disease and can provide information regarding treatment response.4
These measures may incorporate data from a variety of sources, including physician assessments, laboratory values, and patient report.1
Composite disease activity measures requiring physician assessment
* HAQ is most commonly employed as patient measure of physical function.
ACR response criteria2,4,5
Based on average percentage improvement in core measures of disease activity, including patient, physician, and laboratory reports
Boolean-based definition of disease remission8
While different remission assessment tools may be applied depending on the patient context, EULAR and ACR have established consensus on definitions of disease remission in RA.2,9
Radiographic outcomes are an important component of measuring treatment efficacy, with better radiographic outcomes associated with disease remission.2,9,10
Assessing radiographic progression can help to establish the impact of treatment on the functional impairment and structural damage associated with RA.10
Range: variable based on number of joints examined and scaling system
Higher score indicates more joint destruction
While PROs may have some limitations, they have been validated in RA to reflect changes in disease activity over time.2
Higher score means more functional disability
Range: 0-100 mm
Higher score indicates greater pain intensity
Minimal clinically significant change: 11
ACR, American College of Rheumatology; CDAI, Clinical Disease Activity Index; CRP, C-reactive protein; DA, disease activity; DAS, Disease Activity Score; DAS28; Disease Activity Score in 28 joints; DMARD, disease-modifying antirheumatic drug; ESR, erythrocyte sedimentation rate; EULAR, European Alliance of Associations for Rheumatology; HAQ, Health Assessment Questionnaire; mTSS, modified Total Sharp Score; PhGA, physician global assessment; PRO, patient-reported outcome; PtGA, patient global assessment; RA, rheumatoid arthritis; SDAI, Simplified Disease Activity Index; SJC, swollen joint count; TJC, tender joint count; VAS, visual analogue scale.
1. England BR, Tiong BK, Bergman MJ, et al. Arthritis Care Res (Hoboken). 2019;71(12):1540-1555. 2. Salomon-Escoto K, Kay J. Rheum Dis Clin North Am. 2019;45(4):487-504. 3. Kirkham JJ, Boers M, Tugwell P, Clarke M, Williamson PR. Trials. 2013;14:324. 4. Ranganath VK, Yoon J, Khanna D, et al. Ann Rheum Dis. 2007;66(12):1633-1640. 5. Felson DT, LaValley MP. Arthritis Res Ther. 2014;16(1):101. 6. Landewé RBM, van der Heijde D. Ann Rheum Dis. 2020;annrheumdis-2020-216999. 7. Anderson J, Caplan L, Yazdany J, et al. Arthritis Care Res (Hoboken). 2012;64(5):640-647. 8. Felson DT, Smolen JS, Wells G, et al. Ann Rheum Dis. 2011;70(3):404-413. 9. Felson D. Ann Rheum Dis. 2012;71 Suppl 2(0 2):i86-i88. 10. Combe B, Lula S, Boone C, Durez P. Clin Exp Rheumatol. 2018;36(4):658-667. 11. Ory PA. Ann Rheum Dis. 2003;62(7):597-604. 12. Landewé RB, Connell CA, Bradley JD, et al. Arthritis Res Ther. 2016;18(1):212. 13. Fautrel B, Alten R, Kirkham B, et al. Rheumatol Int. 2018;38(6):935-947. 14. Bruce B, Fries JF. Clin Exp Rheumatol. 2005;23(5 Suppl 39):S14-S18. 15. Macedo A, Oakley S, Gullick N, Kirkham B. J Rheumatol. 2009;36(2):225-230. 16. Hawker GA, Mian S, Kendzerska T, French M. Arthritis Care Res (Hoboken). 2011;63 Suppl 11:S240-S252.