Krankheitsaktivitätsmessung bei der Rheumatoiden Arthritis – Warum können wir auf Joint Counts in der Routine verzichten

Zusammenfassung

Die Kranheitsaktivität der rheumatoiden Arthritis (RA) wird in klinischen Studien mit Aktivitätsscores gemessen, die auf einen rheumatologischen Gelenkstatus basieren. Das Erheben von druckschmerzhaften und geschwollenen Gelenken ist dafür unumgänglich. Solch ein Status ist zeitaufwändig und setzt entsprechende Erfahrung voraus. Studien belegen, dass eine hohe inter-Observer Varianz besteht. RA Patienten werden jedoch viel zu selten vom rheumatologischen Facharzt gesehen und nicht einmal diese haben im klinischen Alltag oftmals die Zeit einen solchen Status zu erheben. Patientenzentrierte Scores wie der RADAI-5 oder der RAPID-3 haben gezeigt, dass sie sehr sensibel die Aktivität der RA anzeigen, ja sogar mit geschwollenen und druckschmerzhaften Gelenken signifikant korrelieren beziehungsweise mit Composite Scores wie dem DAS28 oder CDAI. Daher könnten patientenzentrierte Aktivitätsscores zur engmaschigeren Dokumentation des Krankheitsverlaufes im klinischen Alltag einen wesentlichen Beitrag leisten, da der Patient selbst ohne Hilfe diesen aufzeichnen kann und das Errechnen der Scores einen minimalen Zeitaufwand für den behandelnden Arzt darstellt.

Abstract

In clinical trials the disease activity of rheumatoid arthritis (RA) is assessed by scores based on tender and swollen joint counts. These joint counts are time-consuming and require experience in joint assessment. Studies have demonstrated that inter-observer variance in joint assessment is particularly high. RA patients unfortunately are seen only rarely by rheumatologists and even in a busy clinical setting the rheumatologist often does not have enough time to perform a formal rheumatological assessment. Patient-centred disease activity scores for RA such as the RADAI-5 or the RAPID-3 constitute an alternative for busy clinical settings since these short questionnaires are to be completed by the patient him-/herself. They have been shown to exhibit a significant correlation to common composite disease activity scores, such as the DAS28 and the CDAI, as well as to swollen and tender joint counts. And, as a further advantage, these scores require minimal costs and professional time.

Kranankheitsaktivität - DAS28 - RADAI-5 - rheumatoide Arthritis

disease activity - DAS28 - RADAI-5 - rheumatoide arthritis

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