Monitoring disease activity in rheumatoid arthritis
Note: Monitor all patients with rheumatoid arthritis regularly to detect possible flares of disease activity or treatment failure.
Disease activity in people with rheumatoid arthritis (RA) should be monitored at a frequency tailored to individual disease severity and stage of treatment. Inflammation is most reliably monitored by:
- inflammatory signs—number of swollen or tender joints
- inflammatory markers—serum C-reactive protein (CRP) concentration or erythrocyte sedimentation rate (ESR)
- patient-reported outcomes—pain, physical function, psychological health, sleep patterns, relationships, participation in exercise, social and work-related activities.
The patient-reported outcomes can be measured formally or informally. Examples of formal assessment tools include the:
- Stanford health assessment questionnaire (HAQ)
- Routine Assessment of Patient Index Data-3 (RAPID3) questionnaire.
Patient-reported pain without evidence of inflammation suggests the pain may be associated with joint damage, central sensitisation or other painful processes associated with RA; see Residual joint pain in patients in clinical remission.
Joint damage may be assessed by plain X-ray or ultrasound scan. Magnetic resonance imaging (MRI) scan may occasionally be used by specialists.
Rheumatoid factor and antibodies to cyclic citrullinated peptide are not useful in monitoring disease activity.