Table 1.

Health assessment scales

Scale	Description
Paulus index	A composite index for estimating improvement in RA in response to DMARDs. An improvement by 20% in each of 4 of 6 possible measures is required to demonstrate a Paulus 20 response. The measures are: improvement in tender and swollen joint counts; morning stiffness; patients' disease assessment; physicians' disease assessment; and erythrocyte sedimentation rate (ESR) [31].
ACR	Revised criteria (1987) for RA classification by the American College of Rheumatology are:
	i) Morning stiffness ≥1 h
	ii) Soft tissue swelling (arthritis) of 3 or more joints observed by physician
	iii) Swelling of proximal interphalangeal, metacarpophalangeal or wrist joints
	iv) Symmetric swelling (arthritis)
	v) Rheumatoid nodules
	vi) Presence of rheumatoid factor
	vii) Radiographic erosion and/or periarticular osteopenia in hand or wrist joints. Criteria 1–4 must have been present for at least 6 weeks.
ACR patient classification	i) Class I patients able to perform usual activities of daily living
	ii) Class II able to perform self-care, vocational activities, but limited avocational activities
	iii) Class III able to perform self-care, not others
	iv) Class IV limited ability in self-care
ACR20/50/70 response	20%/50%/70% reduction in tender joint count and swollen joint count (≥ 28 joints assessed) and a 20%/50%/70% improvement in at least three of the following
	i) Patients' assessment of pain
	ii) Physician's assessment of disease status
	iii) Patients' assessment of disease status
	iv) Patients' assessment of disability (functional questionnaire)
	v) Acute phase reactant measures (ESR) It has been suggested that a 50% improvement is a more direct indication of suppression of active disease than 20% [32].
Health assessment	A disease specific questionnaire, 20 questions divided into 8 functional categories (2–3 questions per category, i.e. walking, dressing, Questionnaire (HAQ) grooming, etc.), 0 = without difficulty, 3 = unable to do [33].