2019 Update of the American College of Rheumatology Recommended Rheumatoid Arthritis Disease Activity Measures

Abstract

Objective: To provide updated American College of Rheumatology (ACR) recommendations on rheumatoid arthritis (RA) disease activity measurements to facilitate a treat-to-target approach in routine clinical care.

Methods: A working group conducted a systematic literature review from the time of the prior ACR recommendations literature search. Properties of disease activity measures were abstracted, and study quality was assessed using the Consensus-Based Standards for the selection of Health Measurement Instruments 4-point scoring method, allowing for overall level of evidence assessment. Measures that fulfilled a minimum standard were identified, and through a modified Delphi process preferred measures were selected for regular use in most clinic settings.

Results: The search identified 5,199 articles, of which 110 were included in the review. This search identified 46 RA disease activity measures that contained patient, provider, laboratory, and/or imaging data. Descriptions of the measures, properties, study quality, level of evidence, and feasibility were abstracted and scored. Following a modified Delphi process, 11 measures fulfilled a minimum standard for regular use in most clinic settings, and 5 measures were recommended: the Disease Activity Score in 28 Joints with Erythrocyte Sedimentation Rate or C-Reactive Protein Level, Clinical Disease Activity Index, Simplified Disease Activity Index, Routine Assessment of Patient Index Data 3, and Patient Activity Scale-II.

Conclusion: We have updated prior ACR recommendations for preferred RA disease activity measures, identifying 11 measures that met a minimum standard for regular use and 5 measures that were preferred for regular use in most clinic settings.

Figure 1.

Venn diagram of identified rheumatoid arthritis disease activity measures. Venn diagram depicting the major domains of data included in rheumatoid arthritis (RA) disease activity measures: patient reported, provider assessment, laboratory, and imaging. RA disease activity measures are listed in the areas from which they are derived. Abbreviations: CDAI, Clinical Disease Activity Index; DAS, Disease Activity Score; DAS28, Disease Activity Score 28 joints; GAS, Global Arthritis Score; HUPI, Hospital Universitario La Princesa Index; IUS, Individualized Ultrasound Score; ICUS, Individualized Composite Ultrasound Score; K/L antibody, Kappa/Lambda hybrid antibody; MOI-RA, Mean Overall Index for RA; mCDAI, modified Clinical Disease Activity Index; mDAS28, modified Disease Activity Score 28 joints; mDAS28 (no APR), modified Disease Activity Score 28 joints no acute phase reactants; mSDAI, modified Simplified Disease Activity Index; MBDA score, Multibiomarker Disease Activity score; OST, Optical Spectral Transmission; PAS, Patient Activity Scale; PAS-II, Patient Activity Scale-II; PDAS1, Patient Based Disease Activity Score 1; PDAS2, Patient Based Disease Activity Score 2; Pt-CDAI, patient derived Clinical Disease Activity Index; Pt-DAS28, patient derived 28-joint Disease Activity Score; Pt-SDAI, patient derived Simplified Disease Activity Index; PRO-CLARA, Patient Reported Clinical Arthritis Activity; RADAI, Rheumatoid Arthritis Disease Activity Index; RADAI-5; Rheumatoid Arthritis Disease Activity Index-5; RAMRIS, Rheumatoid Arthritis Magnetic Resonance Imaging scoring; RAPID3, Routine Assessment of Patient Index Data 3; RAPID4, Routine Assessment of Patient Index Data 4; RAPID5, Routine Assessment of Patient Index Data 5; SDAI, Simplified Disease Activity Index; SAMIS, Simplified Rheumatoid Arthritis Magnetic Resonance Imaging Score; SONAR, Swiss Sonography in Arthritis and Rheumatism Score; US-6, Ultrasound 6 joint; US-7, Ultrasound 7 joint; US-8, Ultrasound 8 joint; US-12, Ultrasound 12 joint; US-14, Ultrasound 14 joint; US-20, Ultrasound 20 joint; US-28, Ultrasound 28 joint; US-38, Ultrasound 38 joint; US-78, Ultrasound 78 joint; US-Aga, Ultrasound score A & B (proposed by Aga et al.); US-DAS28, Ultrasound derived Disease Activity Score 28 joints; US-SDAI, Ultrasound derived Simplified Disease Activity Index