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.(ABSTRACT TRUNCATED AT 250 WORDS)