Zusammenfassung
Die rheumatoide Arthritis (RA) ist die rheumatische Erkrankung, für die die methodologisch am besten charakterisierten Instrumente zur Verfügung stehen. Für die diversen Aspekte der Erkrankung sind zahllose Messinstrumente verhanden, wobei sich viele nur geringfügig voneinander unterscheiden. Dennoch werden nur wenige Instrumente tatsächlich im klinischen Alltag oder in Studien eingesetzt. Diese umfassen die Verbesserungskriterien der ACR, den DAS, DAS 28, SDAI und CDAI, den HAQ-DI und den SF-36. Der Vergleich klinischer Studien ist durch die Verschiedenartigkeit der Instrumente oft erschwert und erfordert prinzipielle Kenntnis über die Veränderlichkeit der Messinstrumente sowie die Verteilung der Ergebnisse über die potenzielle Skala des Instruments.
Aus wissenschaftlicher Sicht erscheint es notwendig, diese Verlässlichkeit von Instrumenten in ihrem gesamten Wertspektrum zu evaluieren, vor allem aber im unteren Aktivitätsbereich, welchen unsere Patienten durch die neuen Therapiemöglichkeiten immer häufiger erreichen. Werden Instrumente im klinischen Alltag eingesetzt, so ist ein wichtiger Aspekt die Einbindung von Patienten in die Interpretation von Messergebnissen. Ein besseres Verständnis von Messergebnissen kann analog zu anderen Erkrankungen — wie dem Diabetes mellitus oder der arteriellen Hypertonie — zu einer Verbesserung der Patientenmotivation führen und letztlich auch zu besseren Langzeitergebnissen.
Abstract
Rheumatoid arthritis (RA) is the most common systemic inflammatory joint disease. It can be treated effectively with disease modifying antirheumatic drugs, and the currently propagated treatment strategy is to treat RA consequently, and revise the therapeutic approach frequently on the basis of proper disease activity evaluation.
In the current review, we focus on the instruments and measures used in the assessment of RA disease activity. We will first consider the so-called core set measures of activity, prividing comprehensive overviews on joint count scales, global scales, pain scales, biomarkers, and functional assessment instruments. The second part of the review focuses on the value of composite measures of disease activity; a term under which we subsume activity indices using various formulae, self-assessment tools of disease activity, and response criteria.
Among the inflammatory rheumatic diseases, RA is the one for which the most intensive research is done, and usually instruments that work for RA are further tested for other joint diseases. However, there is still a research agenda for the assessment of disease activity, even for RA. One important aspect is to assess the reliability and utility of all available instruments, including the very low end of disease activity, since remission has become an achievable goal. Another focus of disease activity assessment is to derive measures that work in clinical trials and in daily practice, but are also well understood by patients and physicians. This will further improve our ability to care for patients with RA consequently.
Literatur
Aletaha D, Smolen J (2005) The Simplified Disease Activity Index (SDAI) and the Clinical Disease Activity Index (CDAI): a review of their usefulness and validity in rheumatoid arthritis. Clin Exp Rheumatol 23:S100–S108
Aletaha D, Ward M (2005) Duration of rheumatoid arthritis influences the degree of functional Improvement in clinical trials. Ann Rheum Dis 65:227–233
Aletaha D, Smolen JS (2006) The American College of Rheumatology N (ACR-N) debate: going back into the middle of the tunnel? Comment on the articles by Siegel and Zhen and by Boers. Arthritis Rheum 54:377–378
Aletaha D, Nell VP, Stamm T et al. (2005 a) Acute phase reactants add little to composite disease activity indices for rheumatoid arthritis: validation of a clinical activity score. Arthritis Res Ther 7:R796–R806
Aletaha D, Smolen JS, Ward MM (2005 b) Functional limitation in rheumatoid arthritis: how much is reversible? Arthritis Rheum 52 (Suppl): (abstract)
Aletaha D, Ward MM, Machold KP et al. (2005 c) Remission and active disease in rheumatoid arthritis: defining criteria for disease activity states. Arthritis Rheum 52:2625–2636
Aletaha D, Ward MM, Machold KP et al. (2005 d) Remission and active disease in rheumatoid arthritis: defining criteria for disease activity states. Arthritis Rheum 52:2625–2536
Boers M (2005) Use of the American College of Rheumatology N (ACR-N) index of improvement in rheumatoid arthritis: argument in opposition. Arthritis Rheum 52:1642–1645
Boers M, Tugwell P, Felson DT et al. (1994) World Health Organization and International League of Associations for Rheumatology core endpoints for symptom modifying antirheumatic drugs in rheumatoid arthritis clinical trials. J Rheumatol Suppl 41:86–89
Carlsson AM (1983) Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain 16:87–101
Dawes PT, Fowler PD, Clarke S et al. (1986) Rheumatoid arthritis: treatment which controls the C-reactive protein and erythrocyte sedimentation rate reduces radiological progression. Br J Rheumatol 25:44–49
De Andrade JR, Casagrgande PA (1965) A seven-day variability study of 499 patients with peripheral rheumatoid arthritis. Arthritis Rheum 19:302–334
Drossaers-Bakker KW, de Buck M, Van Zeben D (1999) Long-term course and outcome of functional capacity in rheumatoid arthritis: the effect of disease activity and radiologic damage over time. Arthritis Rheum 42:1854–1860
Eberl G, Studnicka-Benke A, Hitzelhammer H et al. (2000) Development of a disease activity index for the assessment of reactive arthritis (DAREA). Rheumatology (Oxford) 39:148–155
Egger MJ, Huth DA, Ward JR et al. (1985) Reduced joint count indices in the evaluation of rheumatoid arthritis. Arthritis Rheum 28:613–619
Emery P, Breedveld FC, Lemmel EM et al. (2000) A comparison of the efficacy and safety of leflunomide and methotrexate for the treatment of rheumatoid arthritis. Rheumatology (Oxford) 39:655–665
Felson DT, Anderson JJ, Boers M et al. (1993) The American College of Rheumatology preliminary core set of disease activity measures for rheumatoid arthritis clinical trials. The Committee on Outcome Measures in Rheumatoid Arthritis Clinical Trials. Arthritis Rheum 36:729–740
Felson DT, Anderson JJ, Boers M et al. American College of Rheumatology (1995) Preliminary definition of improvement in rheumatoid arthritis. Arthritis Rheum 38:727–735
Felson DT, Anderson JJ, Lange ML et al. (1998) Should improvement in rheumatoid arthritis clinical trials be defined as fifty percent or seventy percent improvement in core set measures, rather than twenty percent? Arthritis Rheum 41:1564–1570
Fransen J, Hauselmann H, Michel BA et al. (2001 a) Responsiveness of the self-assessed rheumatoid arthritis disease activity index to a flare of disease activity. Arthritis Rheum 44:53–60
Fransen J, Stucki G, Van Riel PC (2001 b) Rheumatoid arthritis measures. Arthritis Care Res 49:S214–S224
Fries JF, Spitz P, Kraines RG, Holman HR (1980) Measurement of patient outcome in arthritis. Arthritis Rheum 23:137–145
Fuchs HA, Brooks RH, Callahan LF, Pincus T (1989) A simplified twenty-eight-joint quantitative articular index in rheumatoid arthritis. Arthritis Rheum 32:531–537
Goldsmith CH, Smythe HA, Helewa A (1993) Interpretation and power of a pooled index. J Rheumatol 20:575–578
Grigor C, Capell H, Stirling A et al. (2004) Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): a single-blind randomised controlled trial. Lancet 364:263–269
Guillemin F, Coste J, Pouchot J et al. (1997) The AIMS2-SF: a short form of the Arthritis Impact Measurement Scales 2. French Quality of Life in Rheumatology Group. Arthritis Rheum 40:1267–1274
Hart LE, Tugwell P, Buchanan WW et al. (1985) Grading of tenderness as a source of interrater error in the Ritchie articular index. J Rheumatol 12:716–717
Huskisson EC (1974) Measurement of pain. Lancet 2:1127–1131
Jones E, Hanly JG, Mooney R et al. (1991) Strength and function in the normal and rheumatoid hand. J Rheumatol 18:1313–1318
Kapral T, Dernoschnig F, Machold KP et al. (2005) Condensed joint counts in rheumatoid arthritis: are ankles and feet decisive? Ann Rheum Dis 64(Suppl): (abstract)
Katz S, Ford AB, Moskowitz RW et al. (1963) Studies of illness in the aged. The index of ADL: A standardized measure of biological and psychosocial function. JAMA 185:914–919
Kosinski M, Zhao SZ, Dedhiya S et al. (2000) Determining minimally important changes in generic and disease-specific health-related quality of life questionnaires in clinical trials of rheumatoid arthritis. Arthritis Rheum 43:1478–1487
Lansbury J (1956) Quantitation of the manifestations of rheumatoid arthritis. 4. Area of joint surfaces as an index to total joint inflammation and deformity. Am J Med Sci 232:150–155
Lansbury J (1956) Quantitation of the activity of rheumatoid arthritis. 5. A method for summation of the systemic indices of rheumatoid activity. Am J Med Sci 232:300–310
Mallya RK, Mace BE (1981) The assessment of disease activity in rheumatoid arthritis using a multivariate analysis. Rheumatol Rehabil 20:14–17
Mason JH, Meenan RF, Anderson JJ (1992) Do self-reported arthritis symptom (RADAR) and health status (AIMS2) data provide duplicative or complementary information? Arthritis Care Res 5:163–172
Mason JH, Anderson JJ, Meenan RF et al. (1992) The rapid assessment of disease activity in rheumatology (radar) questionnaire. Validity and sensitivity to change of a patient self-report measure of joint count and clinical status. Arthritis Rheum 35:156–162
McHorney CA, Ware JE Jr, Raczek AE (1993) The MOS 36-item short-form health survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care 31:247–263
McHorney CA, Ware JE Jr, Lu JF, Sherbourne CD (1994) The MOS 36-item short-form health survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care 32:40–66
Meenan RF, Gertman PM, Mason JH (1980) Measuring health status in arthritis. The arthritis impact measurement scales. Arthritis Rheum 23:146–152
Meenan RF, Mason JH, Anderson JJ et al. (1992) AIMS2. The content and properties of a revised and expanded Arthritis Impact Measurement Scales Health Status Questionnaire. Arthritis Rheum 35:1–10
Melzack R (1975) The McGill Pain Questionnaire: major properties and scoring methods. Pain 1:277–299
Ng CL, Ho DD, Chow SP (1999) The Moberg pickup test: results of testing with a standard protocol. J Hand Ther 12:309–312
Paulus HE, Egger MJ, Ward JR, Williams HJ (1990) Analysis of improvement in individual rheumatoid arthritis patients treated with disease-modifying antirheumatic drugs, based on the findings in patients treated with placebo. The Cooperative Systematic Studies of Rheumatic Diseases Group. Arthritis Rheum 33:477–484
Pincus T, Callahan LF (1992) Rheumatology function tests: grip strength, walking time, button test and questionnaires document and predict longterm morbidity and mortality in rheumatoid arthritis. J Rheumatol 19:1051–1057
Pincus T, Summey JA, Soraci SA Jr et al. (1983) Assessment of patient satisfaction in activities of daily living using a modified Stanford Health Assessment Questionnaire. Arthritis Rheum 26:1346–1353
Pincus T, Brooks RH, Callahan LF (1991) Reliability of grip strength, walking time and button test performed according to a standard protocol. J Rheumatol 18:997–1000
Pincus T, Brooks RH, Callahan LF (1999) A proposed 30–45 minute 4 page standard protocol to evaluate rheumatoid arthritis (SPERA) that includes measures of inflammatory activity, joint damage, and longterm outcomes. J Rheumatol 26:473–480
Pincus T, Swearingen C, Wolfe F (1999) Toward a multidimensional Health Assessment Questionnaire (MDHAQ): assessment of advanced activities of daily living and psychological status in the patient-friendly health assessment questionnaire format. Arthritis Rheum 42:2220–2230
Plant MJ, Williams AL, O’Sullivan MM et al. (2000) Relationship between time-integrated C-reactive protein levels and radiologic progression in patients with rheumatoid arthritis. Arthritis Rheum 43:1473–1477
Prevoo ML, van Riel PL, ‚t Hof MA et al. (1993) Validity and reliability of joint indices. A longitudinal study in patients with recent onset rheumatoid arthritis. Br J Rheumatol 32:589–594
Prevoo ML, ‚t Hof MA, Kuper HH et al. (1995) Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 38:44–48
Prevoo ML, van Gestel AM, van THM et al. (1996) Remission in a prospective study of patients with rheumatoid arthritis. American Rheumatism Association preliminary remission criteria in relation to the disease activity score. Br J Rheumatol 35:1101–1105
Ritchie DM, Boyle JA, McInnes JM et al. (1968) Clinical studies with an articular index for the assessment of joint tenderness in patients with rheumatoid arthritis. Q J Med 37:393–406
Schiff M, Waever A, Keystone E et al. (1999) Comparison of ACR response, numeric ACR, ACR AUC as measures of clinical improvement in RA clinical trials. Arthritis Rheum 42:S81
Schulz KF, Grimes DA (2005) Multiplicity in randomised trials I: endpoints and treatments. Lancet 365:1591–1595
Scott DL, Garrood T (2000) Quality of life measures: use and abuse. Baillieres Best Pract Res Clin Rheumatol 14:663–687
Scott D, Van Riel PC, van der Heijde DM, Studnicka-Benke A (1993) Assessing disease activity in rheumatoid arthritis — the EULAR handbook of standard methods. On behalf of the EULAR Standing Committee for International Clinical Studies Including Therapeutic Trials — ESCISIT (Chairman: Smolen JS). EULAR, Zürich
Scott DL, Pugner K, Kaarela K et al. (2000) The links between joint damage and disability in rheumatoid arthritis. Rheumatology (Oxford) 39:122–132
Scott J, Huskisson EC (1979) Vertical or horizontal visual analogue scales. Ann Rheum Dis 38:560
Siegel JN, Zhen BG (2005) Use of the American College of Rheumatology N (ACR-N) index of improvement in rheumatoid arthritis: argument in favor. Arthritis Rheum 52:1637–1641
Smolen JS, Aletaha D (2004) Patients with rheumatoid arthritis in clinical care. Ann Rheum Dis 63:221–225
Smolen JS, Steiner G (2003) Therapeutic strategies for rheumatoid arthritis. Nat Rev Drug Discov 2:473–488
Smolen JS, Breedveld FC, Eberl G et al. (1995)Validity and reliability of the twenty-eight-joint count for the assessment of rheumatoid arthritis activity. Arthritis Rheum 38:38–43
Smolen JS, Kalden JR, Scott DL et al. (1999) Efficacy and safety of leflunomide compared with placebo and sulphasalazine in active rheumatoid arthritis: a double-blind, randomised, multicentre trial. European Leflunomide Study Group. Lancet 353:259–266
Smolen JS, Sokka T, Pincus T, Breedveld FC (2003) A proposed treatment algorithm for rheumatoid arthritis: aggressive therapy, methotrexate, and quantitative measures. Clin Exp Rheumatol 21:S209–S210
Smolen JS, Breedveld FC, Schiff MH et al. (2003) A simplified disease activity index for rheumatoid arthritis for use in clinical practice. Rheumatology (Oxford) 42:244–257
St Clair EW, van der Heijde DM, Smolen JS et al. (2004) Combination of infliximab and methotrexate therapy for early rheumatoid arthritis: a randomized, controlled trial. Arthritis Rheum 50:3432–3443
Steinbrocker O, Bloch DA (1946) A therapeutic score card for rheumatoid arthritis. N Engl J Med 14:501–506
Stucki G, Liang MH, Stucki S et al. (1995) A self-administered rheumatoid arthritis disease activity index (RADAI) for epidemiologic research. Psychometric properties and correlation with parameters of disease activity. Arthritis Rheum 38:795–798
Taal E, Rasker JJ, Riemsma RP (2004) Sensitivity to change of AIMS2 and AIMS2-SF components in comparison to M-HAQ and VAS-pain. Ann Rheum Dis 63:1655–1658
Tugwell P, Bombardier C (1982) A methodologic framework for developing and selecting endpoints in clinical trials. J Rheumatol 9:758–762
Van der Heijde DM, ‚t Hof MA, van Riel PL et al. (1990) Judging disease activity in clinical practice in rheumatoid arthritis: first step in the development of a disease activity score. Ann Rheum Dis 49:916–920
Van der Heijde DM, van’t Hof MA, van Riel PL et al. (1992) Validity of single variables and composite indices for measuring disease activity in rheumatoid arthritis. Ann Rheum Dis 51:177–181
Van Gestel AM, Prevoo ML, ‚t Hof MA et al. (1996) Development and validation of the European League Against Rheumatism response criteria for rheumatoid arthritis. Comparison with the preliminary American College of Rheumatology and the World Health Organization/International League Against Rheumatism Criteria. Arthritis Rheum 39:34–40
Van Leeuwen MA, van Rijswijk MH, van der Heijde DM et al. (1993) The acute-phase response in relation to radiographic progression in early rheumatoid arthritis: a prospective study during the first three years of the disease. Br J Rheumatol 32 Suppl 3:9–13
Van Riel PL, Reekers P, van de Putte LB, Gribnau FW (1983) Association of HLA antigens, toxic reactions and therapeutic response to auranofin and aurothioglucose in patients with rheumatoid arthritis. Tissue Antigens 22:194–199
Ware JE J., Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483
Williams HJ, Ward JR, Reading JC et al. (1983) Low-dose D-penicillamine therapy in rheumatoid arthritis. A controlled, double-blind clinical trial. Arthritis Rheum 26:581–592
Williamson A, Hoggart B (2005) Pain: a review of three commonly used pain rating scales. J Clin Nurs 14:798–804
Wolfe F (1994) Data collection and utilization: a methodology for clinical practice and clinical research. In: Wolfe F, Pincus T (eds) Rheumatoid arthritis: pathogenesis, assessment, outcome, and treatment. Dakker, New York
Wolfe F, Michaud K (1994) The clinical and research significance of the erythrocyte sedimentation rate. J Rheumatol 21:1227–1237
Wolfe F, Hawley DJ (1998) The longterm outcomes of rheumatoid arthritis: work disability: a prospective 18 year study of 823 patients. J Rheumatol 25:2108–2117
Wolfe F, O’Dell JR, Kavanaugh A et al. (2001) Evaluating severity and status in rheumatoid arthritis. J Rheumatol 28:1453–1462
Wolfe F, Michaud K, Pincus T (2004) Development and validation of the health assessment questionnaire II: a revised version of the health assessment questionnaire. Arthritis Rheum 50:3296–3305
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Aletaha, D., Stamm, T. & Smolen, J.S. Krankheitsaktivitätsmessung bei rheumatoider Arthritis. Z Rheumatol 65, 93–102 (2006). https://doi.org/10.1007/s00393-006-0041-8
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DOI: https://doi.org/10.1007/s00393-006-0041-8