From the Guidelines
To monitor rheumatoid arthritis (RA) effectively, I recommend regular clinical assessments combined with laboratory tests and imaging studies, as outlined in the 2017 EULAR recommendations for the management of early arthritis 1.
Key Components of Monitoring
- Clinical monitoring should include joint counts (examining 28 joints for tenderness and swelling), patient-reported outcomes using standardized questionnaires like the Health Assessment Questionnaire (HAQ), and composite disease activity scores such as DAS28, CDAI, or SDAI.
- Laboratory monitoring should include erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) to assess inflammation, complete blood count to monitor for medication side effects, and liver and kidney function tests.
- Imaging studies, such as X-rays, ultrasound, or MRI, can be used to detect joint damage and inflammation, and to monitor disease progression.
Frequency of Monitoring
- Patients should have follow-up appointments every 1-3 months during active disease and every 3-6 months during remission.
- The frequency of laboratory tests and imaging studies may vary depending on the individual patient's needs and the severity of their disease.
Additional Considerations
- For patients on specific medications, additional monitoring is necessary: methotrexate requires liver function tests every 1-3 months; biologics require tuberculosis screening before initiation; and JAK inhibitors require lipid profile monitoring.
- A comprehensive monitoring approach allows for timely treatment adjustments to achieve remission or low disease activity, preventing joint damage and disability while minimizing medication side effects, as recommended by the American College of Rheumatology 1.
Imaging Recommendations
- The EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis suggest that ultrasound and MRI can be used to detect joint inflammation and damage, and to monitor disease progression 1.
- Conventional radiography (CR) can be used to detect joint damage, but ultrasound and MRI may be more sensitive for detecting early changes.
Treatment Targets
- The goal of treatment is to achieve remission or low disease activity, as defined by composite disease activity scores such as DAS28, CDAI, or SDAI.
- Treatment should be tailored to the individual patient's needs, and may involve a combination of medications, including DMARDs, biologics, and glucocorticoids.
From the Research
Methods for Monitoring Rheumatoid Arthritis (RA)
The following methods can be used to monitor RA:
- Clinical assessment tools, including biomarkers to indicate RA and disease progression 2
- Disease activity scales, such as the Disease Activity Score 28 (DAS28), the Simplified Disease Activity Index (SDAI), and the Clinical Disease Activity Index (CDAI) to guide diagnoses and monitor patients 2, 3, 4
- Laboratory tests, including radiographs and blood tests for biomarkers, such as rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibodies (anti-CCP) 2, 5
- Patient-focused variables, such as counts of tender and swollen joints, and patient-reported questionnaires to measure pain and global assessment of disease activity 5
- Radiographic assessment of structural changes to mirror joint damage 5
Disease Activity Measures
Disease activity measures, such as composite indices, can provide a comprehensive view of disease activity and include:
- The Disease Activity Score 28 (DAS28) 3, 6
- The American College of Rheumatology criteria 3
- The Clinical Disease Activity Index (CDAI) 3, 4
- The Simplified Disease Activity Index (SDAI) 3, 4
- The Rheumatoid Arthritis Disease Activity Index 3
Monitoring and Assessment Instruments
Monitoring and assessment instruments, such as the DAS28, SDAI, and CDAI, can be used to: