Table 3 Disease monitoring and remission parameters

Disease remission

• Clinical remission: DAS-28: < 2.6

• Ultrasound remission

• Functional good outcome: remission or minimal disease activity Health Assessment Questionnaire (HAQ, 0–3) < 0.5

8.5 ± 0.78

94.4%

H

Low disease activity

• Clinical: DAS-28 between 2.6 and 3.2

• Ultrasound: grade 1 in power Doppler ultrasonography (PDUS)

• Functional good outcome: remission or low disease activity Health Assessment Questionnaire (HAQ, 0–3) < 0.5

8.5 ± 0.78

94.4%

H

Monitoring:

Patients with active RA should be closely monitored on a regular basis, whether they are starting treatment or have seen a flare-up of their disease activity. As a result, it is possible to increase the dosage of disease-modifying antirheumatic drugs (DMARDs), determine whether short-term glucocorticoid bridging therapy is necessary, determine how well patients are handling their medication regimen, monitor side effects, offer support, and promote adherence. The best method for keeping track of and controlling active illness status is disease activity

During the disease course, while monitoring RA patients as follows:

A) Ensure that all adults with RA have the following:

1. Rapid access to specialist care for flares (hot clinic)

2. Information about when and how to access specialist care

3. Ongoing drug monitoring

B) Monitoring should be frequent in active disease or after initiation of DMARD therapy (whether conventional, biologic, or synthetic), every 1–3 months. If there is no improvement by, at most, 3 months, after the start of treatment or the target has not been reached by 6 months, therapy should be adjusted. After achieving treatment target (remission or low disease activity), consider a review appointment to take place every 3–6 months to ensure that the target has been maintained

C. Offer all adults with RA, including those who have achieved the treatment target, an annual review to the following:

○ Assess disease activity and damage and measure functional ability

○ Check for the development of comorbidities, such as hypertension, ischemic heart disease, osteoporosis, and depression

○ Assess symptoms that suggest complications, such as vasculitis and disease of the cervical spine, lung, or eyes

○ Organize appropriate cross referral within the multidisciplinary team

○ Assess the need for referral for surgery

○ Assess the effect the disease is having on a person’s life

○ Assess the comorbidity status

8.72 ± 0.46

100%

H