Management of rheumatoid arthritis.
There is increasing evidence that reduction of disease activity by disease-modifying drugs alters the disease course of rheumatoid arthritis and that patients benefit from early introduction of disease-modifying antirheumatic drugs. To ensure accurate diagnosis and timely referral, training of medical students and residents in rheumatology and access to a physician experienced in the management of rheumatic diseases is important. Because spontaneous remission is rare, the risk of overtreatment of a few patients is outweighed by the benefits of early treatment for the majority of patients. Also, side effects may be reduced with optimation of titration of disease activity based on standardized, reliable, valid, sensitive, and easily interpretable measures with clear-cut decision rules. A potential solution to the practical problems involving the scoring of patient questionnaires such as the Health Assessment Questionnaire and the Rheumatoid Arthritis Disease Activity index and clinical algorithms such as the Disease Activity Score is the provision of a feedback system similar to a laboratory. To feed back the results of titration of disease activity with the goal of permanently improving health outcomes in an ongoing learning process may be called clinical quality management. From a health care system or political perspective, clinical quality management that demonstrates the commitment of rheumatology toward continuous improvement of rheumatoid arthritis care may become an important activity of rheumatology societies in countries where specialty care is under scrutiny and where specialists are increasingly required to show the benefits of their care.
Stucki
G
G
Department of Rheumatology and Physical Medicine, University Hospital Zurich, Switzerland.
Langenegger
T
T
D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D005544:Forecasting; D006801:Humans; D011785:Quality Assurance, Health Care; D012017:Referral and Consultation; D012219:Rheumatology