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Krankheitsaktivitätsmessung bei rheumatoider Arthritis

Measuring disease activity for rheumatoid arthritis

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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.

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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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