Methods of clinical and biological assessment of rheumatoid arthritis

Inflammation has long been recognised as notoriously difficult to measure both in
clinical practice and in the laboratory. Of all the cardinal features of
inflammation, pain relief is really what the patients want, and among disabled
persons, rheumatic patients are the only ones who must cope with chronic pain.
The rheumatologist, however, is also interested in other parameters that are
thought to reflect improvement of the inflammatory process. The methods used to
clinically assess rheumatoid arthritis (RA) should share the following four
parameters: validity, sensitivity, reliability and simplicity. Unfortunately, at
present, no single ideal method is capable of accurately reflecting disease
activity in RA. The measurement of pain relief by the visual analogue scale, the
determination of the Ritchie index and the duration of morning stiffness, plus
patient assessment of global response should be enough to detect clinical
activity of the drug in RA. If we are working with slow-acting drugs or so-called
disease modifying antirheumatic drugs (DMARDs), it should be appropriate to
include X-ray analysis and laboratory tests in the evaluation. A reduction in the
number of fresh erosions and/or the healing of present erosions can give reliable
information on the capacity of the drug to really modify the course of the
disease. At present, measurement of the erythrocyte sedimentation rate and of
acute phase serum proteins seems to offer the best available assessment during
early weeks of therapy. The other biological tests are of limited value in
reflecting or predicting a beneficial clinical response to DMARDs.