类风湿关节炎疾病活动度评估：美国风湿病学会临床实践推荐使用。
Rheumatoid arthritis disease activity measures: American College of Rheumatology recommendations for use in clinical practice.
机构信息
University of Nebraska Medical Center, Omaha, NE, USA.
出版信息
Arthritis Care Res (Hoboken). 2012 May;64(5):640-7. doi: 10.1002/acr.21649.
OBJECTIVE
Although the systematic measurement of disease activity facilitates clinical decision making in rheumatoid arthritis (RA), no recommendations currently exist on which measures should be applied in clinical practice in the US. The American College of Rheumatology (ACR) convened a Working Group (WG) to comprehensively evaluate the validity, feasibility, and acceptability of available RA disease activity measures and derive recommendations for their use in clinical practice.
METHODS
The Rheumatoid Arthritis Clinical Disease Activity Measures Working Group conducted a systematic review of the literature to identify RA disease activity measures. Using exclusion criteria, input from an Expert Advisory Panel (EAP), and psychometric analysis, a list of potential measures was created. A survey was administered to rheumatologists soliciting input. The WG used these survey results in conjunction with the psychometric analyses to derive final recommendations.
RESULTS
Systematic review of the literature resulted in identification of 63 RA disease activity measures. Application of exclusion criteria and ratings by the EAP narrowed the list to 14 measures for further evaluation. Practicing rheumatologists rated 9 of these 14 measures as most useful and feasible. From these 9 measures, the WG selected 6 with the best psychometric properties for inclusion in the final set of ACR-recommended RA disease activity measures.
CONCLUSION
We recommend the Clinical Disease Activity Index, Disease Activity Score with 28-joint counts (erythrocyte sedimentation rate or C-reactive protein), Patient Activity Scale (PAS), PAS-II, Routine Assessment of Patient Index Data with 3 measures, and Simplified Disease Activity Index because they are accurate reflections of disease activity; are sensitive to change; discriminate well between low, moderate, and high disease activity states; have remission criteria; and are feasible to perform in clinical settings.
目的
虽然系统性疾病活动测量有助于类风湿关节炎（RA）的临床决策，但目前尚无关于应在美国临床实践中应用哪些措施的建议。美国风湿病学会（ACR）召集了一个工作组（WG），全面评估现有 RA 疾病活动测量的有效性、可行性和可接受性，并为其在临床实践中的应用提供建议。
方法
类风湿关节炎临床疾病活动测量工作组对文献进行了系统回顾，以确定 RA 疾病活动测量。使用排除标准、专家咨询小组（EAP）的意见和心理测量分析，创建了潜在措施清单。向风湿病医生进行了一项调查，征求他们的意见。WG 使用这些调查结果以及心理测量分析来得出最终建议。
结果
对文献的系统回顾确定了 63 种 RA 疾病活动测量。应用排除标准和 EAP 的评分将名单缩小到 14 项进行进一步评估。实践中的风湿病医生对这 14 项措施中的 9 项评价为最有用和最可行。从这 9 项措施中，WG 选择了 6 项具有最佳心理测量特性的措施纳入最终的 ACR 推荐的 RA 疾病活动测量。
结论
我们建议使用临床疾病活动指数、28 关节计数疾病活动评分（红细胞沉降率或 C 反应蛋白）、患者活动评分（PAS）、PAS-II、常规评估患者指数数据的 3 项措施和简化疾病活动指数，因为它们准确反映疾病活动；对变化敏感；能很好地区分低、中、高疾病活动状态；有缓解标准；并且在临床环境中可行。
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