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Most Rheumatologists Ignore Established Disease Assessment Tools
Katie Eder
Although rheumatologists have an array of disease measurement tools to choose from, they generally choose to ignore all of them when they're assessing rheumatoid arthritis (RA) patients, Jeffrey R. Curtis, MD, MPH, MS, Associate Director of the Center for Education and Research on Therapeutics of Musculoskeletal Disorders at the University of Alabama at Birmingham School of Medicine, said at the American College of Rheumatology (ACR) 2013 Annual Meeting in San Diego, CA.
Even when physicians do take some time out to assess disease activity in their RA patients, Curtis said they either measure erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and cyclic citrullinated peptide (CCP) antibody levels through laboratory testing, or rely on what he called the "'How Ya Doin'?' Brooklyn Health Assessment Questionnaire (HAQ)," which happens more frequently.
"You can't put someone in the RA remission category just based on that kind of Gestalt assessment," Curtis said at the start of the "Fine Tuning Your Skills in Utilizing Disease Activity Measurement Tools for RA" session. "Or maybe it's just as good to do that as it is to do a joint count, but where's the data to show it?"
As Curtis pointed out that the 2012 update of 2009 ACR practice guidelines says "it's not possible or appropriate to mandate the use of a single disease activity score (DAS) for an individual physician," Arthur M. Mandelin, MD, PhD, Assistant Professor of Medicine-Rheumatology at Northwestern University Feinberg School of Medicine, walked attendees through 4 available disease assessment tests — the HAQ, the Routine Assessment of Patient Index Data (RAPID3), the Clinical Disease Activity Index (CDAI), and the DAS based on 28 joints (DAS28) — although he was quick to note that "by no means do I intend to tell you that these are the 4 sublime tests that we should all be using."
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