Key factors
about rheumatoid arthritis
Rheumatic and musculoskeletal diseases (RMDs) comprise over 200 conditions affecting 120 million Europeans
Rheumatoid arthritis is the most common autoimmune inflammatory form of arthritis
RA affects approximately 1 in 100 persons worldwide
Women are 2 to 3 time more likely to be affected by autoimmune for arthritis as men
Arthritis is the leading cause of disability among adults
Source
Memo
for a specialist
Indices used by rheumatologists:
  • ACR 20,50,70
  • DAS28-CRP(ESR)
  • SDAI
  • CDAI
  • ADL: Activities of daily living Boolean-1, Boolean remission with PGA ≤ 1, TJC ≤ 1, SJC ≤ 1, and CRP ≤ 1
  • Boolean-2: Boolean remission with PGA ≤ 2, TJC ≤ 1, SJC ≤ 1, and CRP ≤ 1
  • functional impairment according to the HAQ-DI index (from 0 to 3 points)
Patient-reported outcomes (PROs):
  • Functional impairment according to the HAQ-DI index (from 0 to 3 points)
  • Overall assessment of disease activity by the patient (PAAD; Patient’s Global Assessment of Disease Activity, PtGA) (from 0 to 100 mm) using a visual analogue scale (VAS)
  • Total pain score according to VAS (from 0 to 100 mm)
  • Fatigue on the FACIT Fatigue (Functional Assessment of Chronic Illness Therapy) scale (0 to 52 points)
  • Quality of life according to the EQ-5D questionnaire (European Quality of Life-Five-Dimension Questionnaire)
  • Physical and mental components of the SF-36, including physical functioning, impact of physical condition on daily role functioning (work, daily duties), pain intensity, general health, vitality, social functioning, affective role functioning, and mental health
Main goals
of pharmacotherapy of rheumatoid arthritis
Treat-to-target strategy
Achieving remission (or low activity) of the disease*
Reducing the risk of comorbid diseases that worsen the quality of life and prognosis in patients
Active prescription of anti-inflammatory therapy from the moment of diagnosis ("window of opportunity" up to 12 months from the diagnosis of RA — "early rheumatoid arthritis")
Timely change of the treatment regimen in case of insufficient response to therapy until the goal is achieved
Frequent (at least every 3 months before remission is achieved, every 6 months after remission is achieved) and objective (using quantitative methods) monitoring of the patient’s condition
*reduction of RA activity on the background of treatment during the first 3 months, associated with the development of remission, after 12−24 months
Source
Methodology
for determining the DAS28 assessment of RA activity
disease activity index
DAS28
0,56√TJC
0,28√SJC
0,70lnESR
0,014PGA
tender joint score
swollen joint score (out of 28*)
erythrocyte sedimentation rate
patient global health assessment
+
+
+
=
+
*Out of the following 28 joints: shoulder, elbow, wrist, metacarpophalangeal, proximal interphalangeal, knee, that are affected initially in RA and are available for evaluation
Source
Inflammatory activity in RA
depending on DAS28 index
Remission
DAS28 < 2.6
2.6 < DAS28 < 3.2
Low activity
3.2 < DAS28 < 5.1
Moderate activity
DAS28 > 5.1
High activity
*Clinical Disease Activity Index
Source
CDAI*
— Clinical Disease Activity Index
Methodology of CDAI calculation:

clinical disease activity index
CDAI
SJC (from 28*)
TJC (from 28*)
Swollen joint score
Tender joint
score*
+
+
PGA
Physician global assessment
+
=
+
EGA
Patient global assessment
PGA and EGA approximating on a scale 1−10 (on a VAS)
*Out of the following 28 joints: shoulder, elbow, wrist, metacarpophalangeal, proximal interphalangeal, knee, that are affected initially in RA and are available for evaluation
Source
Rheumatoid arthritis evaluation
depending on CDAI values
Inflammatory activity in RA depending on DAS28 index values
< 2,8
Remission
10 – 22
Moderate activity
2,8 – 10
Low activity
> 22
High activity
Evaluation of therapeutic efficacy depending on reduction of CDAI
CDAI reduction by 15 points
CDAI reduction by 7 points
Good effect
Satisfactory
Source
Visual analogue scale (VAS)
for pain intensity
No pain
Minor pain
Moderate intermittent pain
Moderate persistent pain
Severe pain
Unbearable pain
0-1
1-3
3–5
5–7
7–9
9–10
Source
Achievement of remission
or low disease activity
Source