Évaluation de l’activité de la polyarthrite rhumatoïde

Abstract

The management of RA has changed radically over the last 15years, with the introduction of new drugs and treatment strategies and with the emergence of new concepts: tight control and treat to target. In particular, the necessity to evaluate disease activity using an objective and accurate instrument has been demonstrated. The first composite index developed for assessing disease activity in RA patients was the Disease Activity Score (DAS or DAS44). Then, another group developed a simplified version based on 28 joints instead of 44, the DAS28. However, the DAS44 and DAS28 are based on complex equations, and their determination requires a calculator. This drawback led to the development of simpler indices, the Simplified Disease Activity Index (SDAI) and its modified version, the Clinical Disease Activity Index (CDAI). The DAS28 is currently the most widely used index and is integrated in EULAR response criteria. The objectives of medical treatment in RA may be formulated as to obtain a therapeutic response at least at 3months and to reach the goal at least at 6months. The ultimate goal is to reach a state of remission, especially in early rheumatoid arthritis. However, several definitions of remission coexist: from the most stringent (ACR-EULAR 2011 definition of remission Boolean or SDAI) to the more permissive, DAS28CRP.