Assessing the outcome of rheumatism and focusing on these indicators is right! EULAR 2020.

Don't want to miss Jiemei's push? Poke the blue word "medical rheumatism and nephropathy channel" to pay attention to us and click the "··" menu in the upper right corner and select "set as star" EULAR 2020. Let's listen together! On June 3, the European alliance against Rheumatism (EULAR) 2020 academic conference officially opened.due to the impact of the covid-19 epidemic, this meeting was held online.how to establish and select indicators to evaluate the outcome of rheumatism? Listen to EULAR! Disease evaluation includes patient complaints, clinical evaluation and auxiliary examination.in clinical practice, doctors evaluate the disease throughout the course of the disease, and evaluation indicators widely exist, such as blood pressure, body temperature, joint swelling number, response to treatment, etc.the common characteristics of these evaluation indicators are authenticity, reliability, sensitivity and good feasibility.1 why should we evaluate patients with rheumatism? Taking rheumatoid arthritis (RA) as an example, RA is an autoimmune disease with erosive arthritis as the main clinical manifestation, mainly manifested as symmetrical, chronic, progressive polyarthritis, which can be complicated with lung disease, cardiovascular disease, malignant tumor and depression.therefore, it is very important to evaluate the condition regularly.Professor Isabel castrejon from Madrid mentioned the following three points: to provide an objective explanation of the condition, and to compare the status of patients in two visits, and to help clinical decision-making.control the disease activity as much as possible to achieve disease remission and promote standard treatment.because patients may have complications, fibromyalgia or other injuries, individualized treatment should be carried out.RA lacks a single or definite gold standard to evaluate the disease condition, so it is difficult to evaluate the remission of RA conveniently and accurately.ideally, the assessment tool is from the perspective of both patients and doctors, and the results are feasible, reliable and sensitive.although the above scoring tools have been widely used in clinical work, it will be more meaningful if it can be applied to the daily care of RA patients.in this regard, Professor Isabel castrejon conducted a comparative analysis of commonly used RA scoring tools.the initial assessment of disease activity (DAS) was developed from a large prospective study in which rheumatologists used Das as a standard to define the level of disease activity and decided to use or adjust the treatment of anti rheumatic drugs to improve the condition.DAS28 included the number of swollen joints (SJC), the number of tenderness joints (TJC) and the visual analogue scale (VAS) to obtain the overall evaluation of the patients.however, the results of das28-esr and das28-crp were different. the use of DAS, DAS28 and das28-esr or CRP is complex, which requires joint counting and laboratory testing, and is not applicable during clinical follow-up. in addition, DAS and DAS28 are based on complex formulas, which used to require Das calculators and can now be scored through websites. in 2003, Smolen et al. Developed a simplified disease activity index (SDAI) for clinical practice. they also developed a clinical disease activity index (CDAI), which does not contain any acute phase reactants and can assess disease activity without waiting for laboratory results. in some cases, very high CRP or ESR may be the result of infection or malignant tumor, rather than the increase of inflammatory activity, which may change the choice of treatment and possible intensive treatment. the rapid3 standard is the data obtained from the questionnaire survey of patients. It is the only data obtained by simply relying on the information provided by the patients. It includes function, pain and overall patient assessment (patgl) scores. rapid3 was significantly correlated with DAS28 and CDAI. Rapid3 seems to be more helpful in identifying the improvement of the disease, and it is feasible to apply rapid3 in daily nursing to promote standard treatment. any of these composite indexes can be used in the assessment according to the situation, and the treatment can be adjusted to achieve the lowest disease activity, which is of great significance in the long-term prevention of chronic disability and organ damage. 2 for RA evaluation, these points should be noted! Professor Daniel aletaha from Austria gave the following suggestions: at present, the disease activity score of RA includes DAS, das28-esr, das28-crp, SDAI and CDAI. acute phase reactants (such as ESR or CRP) can provide direct information, which is of great value in the evaluation of disease activity of RA. sometimes acute phase reactants may need to be excluded because they may limit the effectiveness of targeted treatment and there are biases in the evaluation of some treatment methods. RA complications may affect any of these indicators, but this can not be used as a reason to exclude this indicator. the evaluation index of RA needs to be explained by integrating all the complications of patients. 3 how to choose the appropriate outcome evaluation indicators and what problems should clinicians pay attention to? Professor Isabel castrejon gives the following points: from the perspective of patients, it is necessary to consider the ability of patients to fill in the questionnaire: age, education level, cultural and linguistic differences, etc. from the doctor's point of view, the evaluation of patients' daily nursing, the complexity of indicators and the training level of doctors. in terms of feasibility, consider whether it can be done in any place? This includes family practice, such as at home. in terms of cost, is ESR or CRP, complement or other blood samples tested by specific laboratories required? In addition, acceptance of the patient's point of view may promote patients to participate in treatment decision-making and provide guidance for clinical practice. References: [1]. Van der Heijde D et al al.Ann Rheum Dis.1990;49:916;[2].Prevoo MLL et al.Arthritis Rheum.1995;38:44;[3].Smolen JS et al.Rheumatology .2003;42:244;[4].Aletaha D et al.Arthritis Rheum.2005;52:2625.[5].Castrejon I.Best Pract Res Cli Rheumatol.2020:101480.[6].Castrejon I,McCollum L,Tanriover MD,et al,Arthritis Care Res 2012;64:1250-5.