Evaluation of established rheumatoid arthritis

There are two major aspects to evaluate in patients with established RA, na mely (i) the state or progress of the disease, and (ii) the effects of spec ific interventions. The evaluation should include reliable, valid and sensi tive measures of disease activity, tissue damage and health status. It is i mportant to recognise that measures of disease activity can be influenced b y tissue damage as well. Also, in established RA, health status is likely t o be influenced by both disease activity and tissue damage. Whether current rules concerning improvement or remission, which were developed in the con text of early RA, can be applied to established disease has to be investiga ted. While use of radiographs is the current standard method of assessing d amage in established RA, range-of-motion measures and muscle strength indic es may be a more practical and an equally valid alternative. When selecting health status instruments one should carefully explore and pretest possibl e health status measures for specific clinical or study settings.