The ACR recently published two manuscripts addressing the clinical management of rheumatoid arthritis (RA).1,2 One paper provides the ACR’s first recommendations for patient-reported functional status assessment measures for routine clinical use with patients with RA.1 The other updates the ACR’s 2012 recommendations on RA disease activity measures.2,3
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A workgroup of rheumatologists and rheumatology professionals was selected to evaluate the best available evidence for each set of measures. Each group conducted a systematic literature review to identify relevant measures and evaluated them on the basis of study quality, level of evidence and implementation feasibility. From this analysis, the groups developed a list of recommendations for measures preferred for regular use in the clinical management of most patients with RA. They also identified additional measures that met a minimum standard for regular use in most clinic settings.
The senior author of both papers, Kaleb Michaud, PhD, associate professor in the Division of Rheumatology & Immunology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb., says the recommendations were generated to help rheumatologists choose from among the many measures currently available for assessing disease activity and functional status. He cites the more than 60 measures found in the 2012 recommendations for measuring RA disease activity and underscores that some measures are better than others.
“Our task was not to say which is the best, but to say which is the best for everyday use in the clinic,” says Dr. Michaud. “We really needed a process to help recommend the measures for everyday use, especially when doctors want to track the health of their patients over time and get reimbursed.”
Most rheumatology practices already measure RA disease activity and functional status in their patients, Dr. Michaud notes. The feasibility of implementing the preferred measures varies among rheumatology practices given time constraints, experience and comfort level. By including measures that meet a minimum standard for everyday use, the recommendations aim to provide flexibility and additional choices for rheumatologists in a variety of practices, he says. A major goal of the new recommendations is to provide guidance for rheumatologists who aren’t measuring RA disease activity and functional status on a regular basis.
RA Disease Activity Measures: Updated Recommendations
The updated recommendations for RA disease activity measures were based on a systematic review of literature published since the 2012 recommendations.3 The working group found 110 articles that met study criteria, from which they identified 46 RA disease activity measures.1