Rheumatoid Arthritis
Rheumatoid Arthritis: History and Exam
IF a patient has a confirmed diagnosis of rheumatoid arthritis, THEN a measure of each of the following should be documented within 3 months of diagnosis and at least annually thereafter: joint exam, functional status assessment, acute phase reactant, measurement of pain, physician global assessment and patient global assessment.
Rheumatoid Arthritis: Treatment
IF a patient has an established diagnosis of rheumatoid arthritis, THEN the patient should be treated with a DMARD* unless contraindication to DMARD*, inactive disease or patient refusal is documented.
Rheumatoid Arthritis: Treatment
IF a patient has rheumatoid arthritis and is being treated with a DMARD* and there is evidence of increased disease activity or there is evidence of progression of RA bony damage over a 6-month period of time, THEN one of the following should be done: change DMARD* dose or route of administration, change DMARD*, add an additional DMARD*, start or increase dose of glucocorticoids or provide local glucocorticoid injection(s), unless the patient refuses or all of the above are contraindicated.
*DMARD = disease modifying antirheumatic drug, including abatacept, adalimumab, anakinra, azathioprine, cyclosporine, etanercept, gold (oral or intramuscular), hydroxychloroquine, infliximab, leflunomide, methotrexate, minocycline, rituximab and sulfasalazine.
References
Arthritis Foundation Quality Indicator Project (AFQuIP)
Khanna D, Arnold E, Pencharz JN, Grossman JM, Traina SB, Lal A, MacLean CH. Measuring Process of Arthritis Care: The Arthritis Foundation’s Quality Indicator Set for Rheumatoid Arthritis. Semin Arthritis Rheum. 2006;35:211-37.
MacLean CH, Saag KG, Solomon DH, Morton SC, Sampsel S, Klippel JH. Measuring Quality in Arthritis Care: Methods for Developing the Arthritis Foundation’s Quality Indicator Set. Arthritis Rheum. 2004;51:193-202.
British Society for Rheumatology/ Royal College of Physicians (BSR/RCP)
Guideline and audit measures for specialist supervision of patients with rheumatoid arthritis. Report of a Joint Working Group of the British Society for Rheumatology and the Research Unit of the Royal College of Physicians. J Royal College of Physicians of London 1992;26(1):76-82. www.rheumatology.org.uk.
National Committee for Quality Assurance (NCQA) / HEDIS
HEDIS® 2006 Technical Specifications. Disease Modifying Anti-rheumatic Drug Therapy in Rheumatoid Arthritis. Washington, DC. 2005. 160-1.
