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

• Published in: Annals of the rheumatic diseases Vol. 64; no. 9; pp. 1294 - 1298
• Main Authors: Fransen, J, Moens, H Bernelot, Speyer, I, van Riel, P L C M
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and European League Against Rheumatism 01.09.2005; BMJ; BMJ Publishing Group LTD
• Subjects: 28 joint disease activity score; Adrenal Cortex Hormones - administration & dosage; Adrenal Cortex Hormones - adverse effects; Aged; Anti-Inflammatory Agents, Non-Steroidal - administration & dosage; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Antirheumatic Agents - administration & dosage; Antirheumatic Agents - adverse effects; Arthritis, Rheumatoid - drug therapy; Biological and medical sciences; DAS28; decision support; disease activity; disease modifying antirheumatic drug; Diseases of the osteoarticular system; DMARD; Drug Administration Schedule; Drug dosages; Drug Monitoring - methods; Extended Report; Female; Humans; Inflammation; Inflammatory joint diseases; Male; Medical sciences; Methotrexate - administration & dosage; Middle Aged; Patient Compliance; Prednisone - administration & dosage; randomised controlled trial; RCT; Rheumatism; Rheumatoid arthritis; Severity of Illness Index; Studies; Substance abuse treatment; Sulfasalazine - administration & dosage; Treatment Outcome; usual care; Autoimmune disease; Chronic; Inflammatory joint disease; Surveillance; Rheumatoid arthritis; Diseases of the osteoarticular system
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/ard.2004.030924

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.