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Introduction. Since the publication of the recommendations for treating rheumatoid arthritis (RA) to target in 2010, measuring disease activity of a patient with RA using composite scores has become an important concept in the daily clinical practice of a rheumatologist. Although this protocol approach has shown great benefits, the reliability of the scores is under discussion. Furthermore, a discrepancy between components of the scores obtained from patient and is frequently observed. The aim of this master thesis was to reveal how Belgian rheumatologists use these disease activity scores in their daily clinical practice. Methods. A mixed method study was performed including interviews and a survey. The interviews were part of a qualitative study performed and analyzed with the Qualitative Analysis Guide of Leuven (QUAGOL) and served as input for the construction of the survey. For the survey, the Maximum Difference Scaling (MDS) method was used with the aim of revealing the most informative disease activity indicators according to the Belgian rheumatologists (1) in general and (2) in case of discrepancy between the patient’s and physician’s perception on the disease activity. The mean relative importance score (RIS) for each indicator was calculated using hierarchical Bayes modelling. Participants were also asked to indicate their routinely used disease activity score and to explain their choice. Additionally, different characteristics of the rheumatologists were compared for these outcomes. Results. Six Belgian rheumatologists were interviewed. The survey was sent to all Belgian rheumatologists (n=244) and had a total response rate of 83/244 (34%). The number of completely and incompletely filled out surveys was 66/244 (27%) and 17/244 (7%), respectively. The SJC obtained the highest mean±SD RIS (22.54±2.64), followed by the DAS28 (20.61±4.06), echography (16.47±7.97), CRP (13.34±6.11) and PhGA (12.59±7.83). PROs obtained the lowest mean RIS, ranging from 0.34±1.47 to 2.54±2.98. Remarkably, the ESR was less preferred than the CRP, especially for the French-speaking rheumatologists. No important differences were seen in case of discrepancy between the patient and physician. Of the participating rheumatologists, 75/81 (93%) indicated to routinely use a disease activity score, wherefrom the DAS28-CRP (68/81, 84%) and the DAS28-ESR (49/81, 60%) were the most preferred scores. Conclusion. In Belgian rheumatology practice, physician derived measures, the DAS28 and the rheumatologist’s judgement on the disease activity of a patient with RA are the most used indicators to evaluate the disease activity of a patient with RA. More attention needs to be paid on the improvement of the use of PROs.

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Abstract Background. Intensive remission induction therapy consisting of methotrexate (MTX) and short-term glucocorticoids (GC) is currently recommended for patients with early rheumatoid arthritis (RA). If it would be possible to predict which patients would respond insufficiently to this treatment, they could be fast-tracked to other treatment strategies, in order to make maximum use of the early window of opportunity. Objective. To summarize potential determinants of therapy response to currently recommended non-biological intensive remission induction therapy in patients with early RA. Methods. We performed a systematic literature review of studies that identified predictors of remission in RA patients, treated with at least MTX and moderate to high doses of GC. Studies were identified in Medline and Embase. Results. 421 citations were screened, 3 were included. Male sex and ACPA-positivity were predictors of DAS remission. Female sex, long symptom duration, high baseline DAS and HAQ-scores, high BMI, and low response to GC at 2 weeks lowered odds of DAS remission. Predictors of insufficient improvement in HAQ functional ability were high baseline RAI, HAQ and VAS pain. Population and treatment characteristics, outcome variables and variables used to adjust for, differed among studies. Conclusion. Currently, not enough evidence is available to accurately predict therapy response and remission on an individual level. The important negative predictive value of early GC response confirms the importance of rapid re-evaluation after treatment initiation. Previously identified markers of poor prognosis and rapid radiological progression seem ineffective in predicting outcomes of intensive remission induction treatment in patients with early RA. Further research is necessary to develop a reliable predictive model.