Systematic monitoring of disease activity using an outcome measure improves outcomes in rheumatoid arthritis

OBJECTIVE: To systematically review the literature on the value of outcome measures to monitor treatment response in patients with rheumatoid arthritis (RA). METHODS: Canadian rheumatologists participating in the International 3e (evidence expertise exchange) Initiative formulated the question 'Which parameters should be recommended for use in the management of RA patients to assess a clinically meaningful response in clinical practice?'. Searches in 3 electronic databases, Medline, Embase, and Cochrane Central Register of Controlled Trials, yielded no relevant study addressing this question. Experts in the field proposed to extrapolate evidence from 3 randomized controlled trials of systematic monitoring or tight control strategy in the management of RA. RESULTS: Three studies were included in this review. The TICORA study showed that intensive management using systematic monitoring with the Disease Activity Score (DAS) aiming at least low disease activity, monthly followup, and more aggressive disease-modifying antirheumatic drug (DMARD) treatment improves outcomes with higher remission rates (65% vs 16%; p < 0.0001). Fransen, et al demonstrated that targeted therapy aimed at low disease activity (DAS28 < 3.2) led to more changes in DMARD treatment, resulting in a larger number of patients with low disease activity (31% vs 16%; p = 0.028). The CAMERA study showed that systematic monitoring using the objective computer decision program evaluation and monthly followup yielded a greater remission rate (50% vs 37%; p = 0.0001). CONCLUSION: Systematic monitoring of disease activity, aiming for at least low disease activity, and frequent followup improves outcome in RA