Artritis reumatoide

236

Bulletin of the NYU Hospital for Joint Diseases 2009;67(2):236-42

Monitoring Response to Therapy in Rheumatoid Arthritis
Perspectives from the Clinic
Patricia Daul, R.N., and Joseph Grisanti, M.D.

Abstract The major objectives in treating patients with rheumatoid arthritis are managing the symptoms of disease and preserving joint structure, with the ultimate goal of diseaseremission. Several independent studies have shown that treatment decisions driven by quantitative rather than subjective monitoring of disease activity result in significantly improved patient outcomes. Various assessment tools are available that measure both clinical and patient-reported outcomes. While some measurement tools may be more appropriate for use in clinical trials, several have beendeveloped that are simple and practical to use, even in a busy clinic. As pivotal members of the multidisciplinary rheumatology healthcare provider team, the nurse and the rheumatologist play key roles in managing a patient’s progress by closely monitoring their response to treatment. Here, we discuss optimal disease management founded on a multidisciplinary approach and provide an overview of some keymeasures for assessing patient response to treatment.

R

heumatoid arthritis (RA) is a debilitating inflammatory disease with clinical signs and symptoms that include swollen joints, cartilage and bone damage, morning stiffness, and loss of physical function.1 Consequently, patients with severe disease face significant disability, deformity, and irreversible joint damage.1 This chroniccondition can also have a significant negative impact on patients’ health-related quality of life (HRQoL), with many patients experiencing fatigue, decreased sleep quality,

Patricia Daul, R.N., is from the Buffalo Infusion Center, Amherst, New York, and Joseph Grisanti, M.D., is from Buffalo Rheumatology, Orchard Park, New York. Correspondence: Patricia Daul, R.N., Buffalo Infusion Center, 1408 SweetHome Road, Suite 9, Amherst, New York 14228; bicnorth@aol.com.

depression, and reduced work productivity.2,3 Taken together, these symptoms have a detrimental impact on the patient’s physical, social, psychological, and economic well-being. There are two main goals for the treatment of RA by rheumatology healthcare practitioners (HCPs). The first is to make the patient feel better by managingthe symptoms of the disease, and the second is to secure the patient’s future by preserving their joint function, with the ultimate goal of remission.4,5 Disease-modifying antirheumatic drugs (DMARDs) used in the treatment of RA have the potential to reduce and prevent joint damage, as well as to preserve joint integrity and function in patients.1 Nonsteroidal antiinflammatory drugs (NSAIDs) andcorticosteroids are often used as supplemental therapies to help manage the symptoms of the disease.1 Of the currently available DMARDs, traditional nonbiologic therapies include methotrexate, hydroxychloroquine, sulfasalazine, and leflunomide, and biologic therapies include the tumor necrosis factor antagonists etanercept, infliximab, and adalimumab. Other biologic agents include the selectiveT-cell modulator abatacept, the B-cell depleting therapy rituximab, and the interleukin-1 antagonist anakinra.1,6 Traditional and biologic DMARDs have helped many patients to manage their disease.5 The introduction of biologic therapies and their medical benefits, coupled with a trend toward earlier and more aggressive treatment strategies, has resulted in major clinical progress in patients withmoderate-to-severe RA that rarely have been seen previously.4,5 However, despite the proven efficacy of available biologic therapies in improving clinical, radiographic, and HRQoL outcomes, not all patients respond equally to the same therapy.7 Therefore, having an effective strategy for monitoring treatment response is essential to achieving the long-term disease management goals of each patient....