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Evaluating the adequacy of disease control in patients with rheumatoid arthritis: a RAND appropriateness panel.

Publication ,  Journal Article
Furst, DE; Halbert, RJ; Bingham, CO; Fukudome, S; Anderson, L; Bonafede, P; Bray, V; Cohen, SB; Sherrer, YRS; St Clair, EWS; Tesser, JRP ...
Published in: Rheumatology (Oxford)
February 2008

OBJECTIVES: There is a lack of agreement on assessing disease activity in patients with RA and determining when the RA treatment should be changed or continued. A panel of rheumatologists was convened to develop guidelines to assess adequacy of disease control, focusing on the use of disease-modifying anti-rheumatic drugs. METHODS: The Research and Development/University of California in Los Angeles (RAND/UCLA) Appropriateness Method was used to evaluate disease control adequacy. After a literature review, 108 scenarios were developed to simulate situations most likely to be encountered in clinical practice and rated on a 9-point scale by a 10-member expert panel. RESULTS: Final appropriateness rankings for the scenarios were as follows: 37% 'appropriate', 48% 'inappropriate', and 16% 'neutral'. The panelists felt that patients with disease control in the 'appropriate' range have adequate control with their current therapy, whereas those in the 'inappropriate' range should be considered for a change in therapy. Those in 'neutral' areas should have their therapy reviewed carefully. The panelists recommended that the clinically active joint count should be considered the most important decision factor. In patients with no clinically active joints, regardless of other factors no change in therapy was felt to be warranted. Patients with five or more active joints should be considered inadequately treated, and in patients with one to four active joints other variables must be considered in the decision to change therapy. CONCLUSION: These preliminary guidelines will assist the clinician in determining when a patient's clinical situation warrants therapy escalation and when continuing the current regimen would be appropriate.

Duke Scholars

Published In

Rheumatology (Oxford)

DOI

EISSN

1462-0332

Publication Date

February 2008

Volume

47

Issue

2

Start / End Page

194 / 199

Location

England

Related Subject Headings

  • Treatment Outcome
  • Reproducibility of Results
  • Predictive Value of Tests
  • Humans
  • Evidence-Based Medicine
  • Evaluation Studies as Topic
  • Delivery of Health Care
  • Clinical Trials as Topic
  • Arthritis, Rheumatoid
  • Arthritis & Rheumatology
 

Citation

APA
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Furst, D. E., Halbert, R. J., Bingham, C. O., Fukudome, S., Anderson, L., Bonafede, P., … Dubois, R. W. (2008). Evaluating the adequacy of disease control in patients with rheumatoid arthritis: a RAND appropriateness panel. Rheumatology (Oxford), 47(2), 194–199. https://doi.org/10.1093/rheumatology/kem326
Furst, D. E., R. J. Halbert, C. O. Bingham, S. Fukudome, L. Anderson, P. Bonafede, V. Bray, et al. “Evaluating the adequacy of disease control in patients with rheumatoid arthritis: a RAND appropriateness panel.Rheumatology (Oxford) 47, no. 2 (February 2008): 194–99. https://doi.org/10.1093/rheumatology/kem326.
Furst DE, Halbert RJ, Bingham CO, Fukudome S, Anderson L, Bonafede P, et al. Evaluating the adequacy of disease control in patients with rheumatoid arthritis: a RAND appropriateness panel. Rheumatology (Oxford). 2008 Feb;47(2):194–9.
Furst, D. E., et al. “Evaluating the adequacy of disease control in patients with rheumatoid arthritis: a RAND appropriateness panel.Rheumatology (Oxford), vol. 47, no. 2, Feb. 2008, pp. 194–99. Pubmed, doi:10.1093/rheumatology/kem326.
Furst DE, Halbert RJ, Bingham CO, Fukudome S, Anderson L, Bonafede P, Bray V, Cohen SB, Sherrer YRS, St Clair EWS, Tesser JRP, Weinblatt M, Dubois RW. Evaluating the adequacy of disease control in patients with rheumatoid arthritis: a RAND appropriateness panel. Rheumatology (Oxford). 2008 Feb;47(2):194–199.
Journal cover image

Published In

Rheumatology (Oxford)

DOI

EISSN

1462-0332

Publication Date

February 2008

Volume

47

Issue

2

Start / End Page

194 / 199

Location

England

Related Subject Headings

  • Treatment Outcome
  • Reproducibility of Results
  • Predictive Value of Tests
  • Humans
  • Evidence-Based Medicine
  • Evaluation Studies as Topic
  • Delivery of Health Care
  • Clinical Trials as Topic
  • Arthritis, Rheumatoid
  • Arthritis & Rheumatology