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The challenges of determining RA disease activity and remission in clinical practice

Nature Clinical Practice Rheumatology volume 4, pages 462–463 (2008)Cite this article

Current tools to assess disease activity in rheumatoid arthritis (RA) are neither precise nor accurate. Precision is the degree of detail that can be determined reliably; accuracy refers to the truthfulness or correctness of the data. In clinical trials, lack of precision can be overcome by large sample sizes, and accuracy defects can be resolved by agreement among investigators as to the meaning of the results. Neither of these corrections can be used in clinical practice.

RA activity and remission (which we will henceforth call activity, since remission represents a point along the activity scale) includes physician measures (joint swelling, tenderness, and global assessment), laboratory measures (C-reactive protein [CRP] level and erythrocyte sedimentation rate [ESR]), and patient measures (pain, function, and global severity). These scales are commonly combined into various activity indices, such as the American College of Rheumatology revised core set,1 the Disease Activity Scale (DAS),2 the Clinical Disease Activity Index (CDAI) scores,3 and patient measures such as the Patient Activity Scale (PAS) and the RAPID-3.4,5

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Author information

Authors and Affiliations

  1. F Wolfe is the Director of the National Data Bank for Rheumatic Diseases, and Clinical Professor of Medicine at the University of Kansas School of Medicine, Wichita, KS, USA.,

    Frederick Wolfe

  2. K Michaud is a Research Scientist at the National Data Bank for Rheumatic Diseases, Wichita, KS, USA, and an Assistant Professor of Medicine at the University of Nebraska Medical Center, Omaha, NE, USA.,

    Kaleb Michaud

Authors
  1. Frederick Wolfe
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  2. Kaleb Michaud
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Correspondence to Frederick Wolfe.

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The authors declare no competing financial interests.

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Wolfe, F., Michaud, K. The challenges of determining RA disease activity and remission in clinical practice. Nat Rev Rheumatol 4, 462–463 (2008). https://doi.org/10.1038/ncprheum0859

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