What are the ACR recommendations for the measurement of rheumatoid arthritis (RA) disease activity?

Updated: Feb 07, 2020
  • Author: Howard R Smith, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

In 2012, the ACR published revised recommendations for the measurement of disease activity for clinical use at the point of care. The scales used included the following recommended measures [2] :

  • Patient-driven composite tools – PAS (patient activity scale): scale, 0-10; PAS II: scale, 0-10; RAPID-3 (routine assessment of patient index data with 3 measures): scale, 0-10
  • Patient and provider composite tool& ndash; CDAI (clinical disease activity index): scale, 0-76
  • Patient, provider, and laboratory composite tools – DAS28 (28-joint disease activity score, using either the erythrocyte sedimentation rate [ESR] or C-reactive protein [CRP] level): scale, 0-9.4; SDAI (simplified disease activity index): scale, 0-86

The 6 measures above result in a single continuous index with defined ranges for low, moderate, or high disease activity or clinical remission. [2] See Table 3, below.

Table 3. Rheumatoid Arthritis Disease Activity Cutoffs (Open Table in a new window)

Tool Type

Tool

Low/Minimal Disease

Moderate Disease

High/Severe Disease

Patient-driven composite

PAS, PAS

0.26–3.70

3.71 to < 8.0

8.00–10.00

PASII

0.26–3.70

3.71 to < 8.0

8.00–10.00

Patient and provider composite

RAPID-3

>1.0–2.0

>2.0–4.0

>4.0–10

Patient, provider, and laboratory composite

CDAI

2.8–10.0

>10.0–22.0

>22.0

DAS28

2.6 to < 3.2

3.2–5.1

>5.1

SDAI

>3.3–11.0

>11.0 to 26

>26

PAS= Patient Activity Scale; RAPID-3 = Routine Assessment of Patient Index Data with 3 measures; CDAI = Clinical Disease Activity Index; DAS28 = 28-joint Disease Activity Score (with either erythrocyte sedimentation rate or C-reactive protein level); SDAI = Simplified Disease Activity Index


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