INFO - EULAR recommendations for the managment of early arthritis

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Published Online First: 5 January 2006. doi:10.1136/ard.2005.044354

ls of the Rheumatic Diseases 2007;66:34-45

Copyright © 2007 BMJ Publishing Group Ltd & European League Against

Rheumatism

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EXTENDED REPORT

EULAR recommendations for the management of early arthritis: report of a

task force of the European Standing Committee for International Clinical

Studies Including Therapeutics (ESCISIT)

Excerpt:

Recommendation 12

Monitoring of disease activity should include tender and swollen joint

count, patient's and physician's global assessments, ESR, and CRP.

Arthritis activity should be assessed at one to three month intervals,

for as long as remission is not achieved. Structural damage should

be assessed by x rays every 6 to 12 months during the first few

years. Functional assessment (for example, HAQ) can be used to

complement the disease activity and structural damage monitoring.

This statement is supported by at least three RCTs.7,14,145 In the TICORA

study, patients with recent onset rheumatoid arthritis were randomly

assigned to receive routine DMARD treatment at the discretion of the

treating rheumatologist, or intensive treatment with monthly assessment of

clinical disease activity.14 In this latter group, the treatment was

intensified or drug combinations were used if the effect on disease activity

was insufficient, as defined by a DAS44 <2.4. This intensive strategy

appeared to be significantly more effective at all follow up visits

throughout the first 18 months, in terms of both clinical symptoms and

radiographic progression.

Intensive care based on regular monitoring of DAS28 or DAS44 was associated

with better outcome in two recent trials,7,145 and other validated composite

indices can be used to monitor disease activity equally reliably.146 No

evidence from an appropriately designed clinical trial exists to support

monitoring of radiographic progression. The expert committee considered

monitoring of radiographic progression useful in view of the objective of

the management of early arthritis (to prevent joint destruction), the

observation that radiographic progression is greatest during the first two

years after disease onset, and the appreciation that radiographic

progression is clinically meaningful in case of a change of 4 Sharp units

(during six months follow up) and can be reliably established at the group

level after a three to six months interval147 (category III). In order to

facilitate radiographic monitoring, it could be desirable to use the simple

erosion and narrowing score (SENS), a scoring method based on the van der

Heijde modified Sharp score and validated for use in clinical practice.148

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