Key Points
` Focus on common clinical scenarios, not exceptional cases.
` Cost is a consideration in these recommendations. However, explicit
cost-effectiveness analyses were not conducted.
` Disease activity measurement using an ACR-recommended measure
should be performed in a majority of encounters with patients with
rheumatoid arthritis (RA).
1
` Functional status assessment using a standardized, validated measure
should be performed routinely for RA patients, at least once per year,
but more frequently if disease is active. Examples of commonly used
functional status measures include Health Assessment Questionnaire
(HAQ), Health Assessment Questionnaire-II (HAQ-II), Multidimensional
Health Assessment Questionnaire (MD-HAQ), Patient-Reported
Outcomes Measurement Information System (PROMIS; available
through https://www.assessmentcenter.net/) Physical Function
10-item, PROMIS Physical Function 20-item, and PROMIS Physical
Function Computerized Adaptive Tests (PROPFCAT).
` If a patient has low RA disease activity or is in clinical remission,
switching from one therapy to another should be considered only at the
discretion of the treating physician in consultation with the patient.
Arbitrary switching between RA therapies based only on a payer/
insurance company policy is not recommended.
` A treatment recommendation favoring one medication over another
means that the preferred medication would be the recommended first
option. However, favoring one medication over the other does not imply
that the non-favored medication is contraindicated for use in that
situation; it may still be a potential option under certain conditions.
Table 1. Definitions
Key Terms Definitions
Adult RA
patient
Adults, 18 years and older, meeting the ACR RA classification
criteria.
2
,
3
Health Benefits
and Harms
Efficacy and safety of treatments including desirable and undesirable
effects.
Early RA RA with duration of disease/symptoms of <6 months, where
"duration" denotes the length of time the patient has had symptoms/
disease, not the length of time since RA diagnosis.
Established RA RA with duration of disease/symptoms of ≥6 months OR meeting
1987 ACR RA classification criteria.
a
