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Research ArticleArticles

Assessment and Management of Rheumatoid Arthritis

BOULOS HARAOUI
The Journal of Rheumatology Supplement June 2009, 82 2-10; DOI: https://doi.org/10.3899/jrheum.090124
BOULOS HARAOUI
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  • For correspondence: bharaoui{at}videotron.ca
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    Figure 1.

    ACR recommendations for the initiation of non-biologic disease modifying antirheumatic drugs in patients with disease duration < 6 months (A), 6 to 12 months (B), and > 12 months (C)9. §Recommended only for patients with high disease activity with features of poor prognosis. IIRecommended only for patients with moderate disease activity irrespective of prognostic features and patients with high disease activity without features of poor prognosis. # Recommended only for patients with high disease activity without features of poor prognosis. HCQ: hydroxychloroquine; LEF: leflunomide; MTX: methotrexate; SSZ: sulfasalazine; MIN: minocycline. Reprinted from Arthritis Rheum 2008;59:762–84, with permission.

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    Figure 2.

    American College of Rheumatology recommendations for the initiation of biologic disease-modifying antirheumatic drugs (DMARD) in patients with disease duration of less than 6 months (A), 6 to 12 months (B), or longer than 12 months (C)9. § Recommended only for patients with high disease activity with features of poor prognosis. MTX: Methotrexate; TNF: Tumor necrosis factor. Reprinted from Arthritis Rheum 2008;59:762–84, with permission.

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    Figure 3.

    Survival curve for anti-tumor necrosis factor (TNF) usage among 488 patients (68% with RA) in a Spanish register during the first 2 years of treatment26.

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    Figure 4.

    European League Against Rheumatism (EULAR) response rates 3 months after initiation of anti-tumor necrosis factor (TNF) therapy in 488 patients in a Spanish register27.

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    Figure 5.

    American College of Rheumatology (ACR) response rates among patients with rheumatoid arthritis who were switched to treatment with abatacept or placebo following failure to respond to an anti-tumor necrosis factor (TNF) therapy in the ATTAIN trial32. Reprinted from N Engl J Med 2005;353:1114–23, with permission.

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    Figure 6.

    American College of Rheumatology (ACR) response rates over time among patients with rheumatoid arthritis who were originally switched to treatment with abatacept (A) or placebo (B) following failure to respond to an anti-tumor necrosis factor (TNF) therapy in the longterm extension of the ATTAIN trial33. Reprinted from Ann Rheum Dis 2008;67:547–54, with permission.

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    Table 1.

    Elements of composite indices for evaluation of disease activity in rheumatoid arthritis4. Values in parentheses are ranges.

    ElementsSDAICDAIDASDAS28
    Number of swollen jointsSimple count (0–28)Simple Count (0–28)(0–2.86)More extensive joint counts transformed (0–1.48)Simple count, square root
    Number of tender jointsSimple count (0–28)Simple Count (0–28)Ritchie Index: graded joint counts; square root transformed (0–4.77)Simple count; square root transformed (0–2.96)
    Acute-phase reactantsCRP in mg/dl (0.1–10.0)—ESR, log transformed (0.23–1.51)*ESR, log transformed (0.49–3.22)*
    Patient global health——VAS in mm (0–0.72)*VAS in mm (0–1.40)*
    Patient global disease activityVAS in cm (0–10.0)VAS in cm (0–10.0)——
    Evaluator global disease activityVAS in cm (0–10.0)VAS in cm (0–10.0)——
    Total IndexNo immediate scoring due to CRP; simple calculation possible (0.1–86.0)Immediate scoring possible; simple calculation possible (0–76.0)No immediate scoring due to ESR; calculator required (0.23–9.87)No immediate scoring due to ESR; calculator required (0.49–9.07)
    • ↵* The DAS and DAS28 formulae have also been modified to include CRP instead of ESR, and to substitute the patient global health by a constant. These versions are less commonly used and not well validated. SDAI: Simplified Disease Activity Index; CDAI: Clinical DAI; DAS: Disease Activity Score; CRP: C-reactive protein; ESR: erythrocyte sedimentaion rate. Reprinted from J Clin Exp Rheumatol 2005;23 Suppl 39:S100–8 with permission.

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The Journal of Rheumatology Supplement
Vol. 82
1 Jun 2009
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Assessment and Management of Rheumatoid Arthritis
BOULOS HARAOUI
The Journal of Rheumatology Supplement Jun 2009, 82 2-10; DOI: 10.3899/jrheum.090124

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    • Abstract
    • INSTRUMENTS RECOMMENDED FOR ASSESSMENT OF RA IN DAILY CLINICAL PRACTICE
    • RECOMMENDATIONS FOR THE MANAGEMENT OF EARLY RA
    • CONCEPTS OF TIGHT CONTROL AND TREATING TO TARGET
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