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Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 2005 Apr 13;64(9):1294–1298. doi: 10.1136/ard.2004.030924

Effectiveness of systematic monitoring of rheumatoid arthritis disease activity in daily practice: a multicentre, cluster randomised controlled trial

J Fransen 1, H Moens 1, I Speyer 1, P L C M van Riel 1
PMCID: PMC1755664  PMID: 15829574

Abstract

Objective: To test the efficacy of standardised monitoring using the disease activity index DAS28 versus usual care on disease modifying antirheumatic drug (DMARD) prescription and disease activity in rheumatoid arthritis.

Methods: A 24 week cluster randomised trial. Rheumatology outpatient centres were randomised to systematic monitoring of disease activity using the DAS28 (12 centres, 205 patients) or usual care (12 centres, 179 patients). The aim for the DAS group was to reach a DAS28 score of ⩽3.2 by changes in DMARD treatment, at the discretion of the rheumatologist and the patient.

Results: At baseline, disease activity was the same in both groups, with an overall mean (SD) DAS28 of 4.5 (1.2); 13% of the patients had a DAS28 of ⩽3.2. At 24 weeks, 31% of patients in the DAS group had a DAS28 ⩽3.2, while in the usual care centres this was 16% (p = 0.028). DMARDs were changed on average in 18% of visits in the DAS centres; in the 12 usual care centres they were changed on 8% of the visits (p = 0.013). The doses of methotrexate, sulfasalazine, and corticosteroids appeared to be higher in the DAS centres than in the usual care centres, but the differences were not significant.

Conclusions: In daily practice, systematic monitoring of disease activity in rheumatoid arthritis may lead to more changes in DMARD treatment, resulting in a larger number of patients with low disease activity.

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Figure 1.

Figure 1

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 In the disease activity score (DAS) group, more patients reached low disease activity (DAS28 ⩽3.2) than in the usual care (UC) group (p = 0.028).

Figure 2.

Figure 2

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 In the disease activity score (DAS) group, more changes in disease modifying antirheumatic drug (DMARD) treatment occurred during the course of the study (p = 0.013).

Figure 3.

Figure 3

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 Mean dose of methotrexate (A), sulfasalazine (B), and oral prednisone (C) during the course of the study.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bland J. M. Sample size in guidelines trials. Fam Pract. 2000 Feb;17 (Suppl 1):S17–S20. doi: 10.1093/fampra/17.suppl_1.s17. [DOI] [PubMed] [Google Scholar]
  2. Canadian Rheumatology Association annual meeting. Mont Tremblant, Quebec, Canada. February 21-24, 2001. Abstracts. J Rheumatol. 2001 Jun;28(6):1413–1422. [PubMed] [Google Scholar]
  3. Fransen J., Laan R. F. J. M., Van Der Laar M. A. F. J., Huizinga T. W. J., Van Riel P. L. C. M. Influence of guideline adherence on outcome in a randomised controlled trial on the efficacy of methotrexate with folate supplementation in rheumatoid arthritis. Ann Rheum Dis. 2004 Oct;63(10):1222–1226. doi: 10.1136/ard.2003.018861. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Fransen J., Stucki G., Twisk J., Chamot A-M, Gerster J-C, Langenegger T., Seitz M., Michel B. A., mebers of the Swiss Clinical Quality Management in Rheumatoid Arthritis (SCQM) Effectiveness of a measurement feedback system on outcome in rheumatoid arthritis: a controlled clinical trial. Ann Rheum Dis. 2003 Jul;62(7):624–629. doi: 10.1136/ard.62.7.624. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Fransen J., Stucki G., van Riel P. The merits of monitoring: should we follow all our rheumatoid arthritis patients in daily practice? Rheumatology (Oxford) 2002 Jun;41(6):601–604. doi: 10.1093/rheumatology/41.6.601. [DOI] [PubMed] [Google Scholar]
  6. Fransen Jaap, Twisk Jos W. R., Creemers Marjonne C. W., van Riel Piet L. C. M. Design and analysis of a randomized controlled trial testing the effects of clinical decision support on the management of rheumatoid arthritis. Arthritis Rheum. 2004 Feb 15;51(1):124–127. doi: 10.1002/art.20087. [DOI] [PubMed] [Google Scholar]
  7. Grigor Catriona, Capell Hilary, Stirling Anne, McMahon Alex D., Lock Peter, Vallance Ramsay, Kincaid Wilma, Porter Duncan. Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): a single-blind randomised controlled trial. Lancet. 2004 Jul 17;364(9430):263–269. doi: 10.1016/S0140-6736(04)16676-2. [DOI] [PubMed] [Google Scholar]
  8. Moreland L. W., Russell A. S., Paulus H. E. Management of rheumatoid arthritis: the historical context. J Rheumatol. 2001 Jun;28(6):1431–1452. [PubMed] [Google Scholar]
  9. Welsing P. M., van Gestel A. M., Swinkels H. L., Kiemeney L. A., van Riel P. L. The relationship between disease activity, joint destruction, and functional capacity over the course of rheumatoid arthritis. Arthritis Rheum. 2001 Sep;44(9):2009–2017. doi: 10.1002/1529-0131(200109)44:9<2009::AID-ART349>3.0.CO;2-L. [DOI] [PubMed] [Google Scholar]
  10. Welsing Paco M. J., Landewé Robert B. M., van Riel Piet L. C. M., Boers Maarten, van Gestel Anke M., van der Linden Sjef, Swinkels Hilde L., van der Heijde Désirée M. F. M. The relationship between disease activity and radiologic progression in patients with rheumatoid arthritis: a longitudinal analysis. Arthritis Rheum. 2004 Jul;50(7):2082–2093. doi: 10.1002/art.20350. [DOI] [PubMed] [Google Scholar]
  11. Zandbelt M. M., Welsing P. M., van Gestel A. M., van Riel P. L. Health Assessment Questionnaire modifications: is standardisation needed? Ann Rheum Dis. 2001 Sep;60(9):841–845. [PMC free article] [PubMed] [Google Scholar]
  12. van Gestel A. M., Haagsma C. J., van Riel P. L. Validation of rheumatoid arthritis improvement criteria that include simplified joint counts. Arthritis Rheum. 1998 Oct;41(10):1845–1850. doi: 10.1002/1529-0131(199810)41:10<1845::AID-ART17>3.0.CO;2-K. [DOI] [PubMed] [Google Scholar]

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