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DC-ART: improvement and sustained improvement in function

P Tugwell1, P Baker

  • 1Department of Medicine, University of Ottawa, Ontario, Canada.

The Journal of Rheumatology. Supplement
|September 1, 1994
PubMed
Summary
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Defining success for Disease-Modifying Antirheumatic Drugs (DMARDs) requires quantifying physical function improvements. Clinicians may use a 25-50% improvement as a benchmark for meaningful change in rheumatoid arthritis treatment.

Area of Science:

  • Rheumatology
  • Clinical Trial Design
  • Rehabilitation Medicine

Background:

  • The Disease-Modifying Antirheumatic Drugs (DMARDs) category requires clear criteria for treatment success.
  • Current definitions of 'function' encompass physical, social, and emotional aspects.
  • A precise, quantitative measure for functional improvement in DMARD therapy is lacking.

Purpose of the Study:

  • To propose a quantitative definition for 'improved and sustained function' within the DC-ART (Disease-Modifying Antirheumatic Drugs) category.
  • To advocate for a focus on physical function as the primary outcome measure for DC-ART.
  • To establish a clinically relevant benchmark for functional improvement in rheumatoid arthritis.

Main Methods:

  • Literature review and conceptual analysis of functional outcome measures in rheumatology.

Related Experiment Videos

  • Examination of existing clinical practice and historical benchmarks for 'clinically important change'.
  • Discussion of data limitations regarding predictive value and natural disease course.

    • Main Results:

    • A case is made for defining 'function' strictly as physical function for DC-ART criteria.
    • Current data are insufficient to precisely define the minimal clinically important difference in physical function.
    • A provisional benchmark of 25-50% improvement in physical function is suggested, based on clinical consensus.

    Conclusions:

    • The DC-ART category necessitates a refined, quantitative definition centered on physical function improvement.
    • A 25-50% improvement in physical function serves as a practical, albeit arbitrary, interim standard for DC-ART.
    • Further research is needed to establish more robust predictive data for long-term benefits of DC-ART.