Effectiveness of systematic monitoring of rheumatoid arthritis disease activity in daily practice: a multicentre, cluster randomised controlled trial

Objective: To test the efficacy of standardised monitoring using the disease activity index DAS28 versus usual care on disease modifying antirheumatic drug ( DMARD) prescription and disease activity in rheumatoid arthritis. Methods: A 24 week cluster randomised trial. Rheumatology outpatient centres were randomised to systematic monitoring of disease activity using the DAS28 ( 12 centres, 205 patients) or usual care ( 12 centres, 179 patients). The aim for the DAS group was to reach a DAS28 score of <= 3.2 by changes in DMARD treatment, at the discretion of the rheumatologist and the patient. Results: At baseline, disease activity was the same in both groups, with an overall mean (SD) DAS28 of 4.5 (1.2); 13% of the patients had a DAS28 of <= 3.2. At 24 weeks, 31% of patients in the DAS group had a DAS28 <= 3.2, while in the usual care centres this was 16% ( p = 0.028). DMARDs were changed on average in 18% of visits in the DAS centres; in the 12 usual care centres they were changed on 8% of the visits ( p = 0.013). The doses of methotrexate, sulfasalazine, and corticosteroids appeared to be higher in the DAS centres than in the usual care centres, but the differences were not significant. Conclusions: In daily practice, systematic monitoring of disease activity in rheumatoid arthritis may lead to more changes in DMARD treatment, resulting in a larger number of patients with low disease activity.