Clinical quality management in rheumatoid arthritis: putting theory into practice

Clinical quality managment (CQM) in rheumatoid arthritis (RA) aims to reduc e inflammatory activity and pain in the short term, and damage, and consequ ently disability, in the long term. Within CQM as used in Switzerland rheum atologists are provided with a measurement feedback system with which they can regularly follow their patients. Inflammatory activity is measured with the Disease Activity Score (DAS28) and the Rheumatoid Arthritis Disease Ac tivity Index questionnaire (RADAI), damage with an X-ray score and disabili ty with the Stanford Health Assessment Questionnaire (HAQ). Feedback is use d to optimize therapy, which in the short term allows the activity of the i nflammatory process to be adjusted or 'titrated'. In the long term, the the rapy result for the individual patient is monitored by the course of disabi lity and damage. In this paper we present a series of cases to illustrate t he usefulness of the CQM system in the management of individual RA patients . CQM in RA may be helpful when making decisions about adjustment of treatm ent, and to document and communicate these decisions based on quantitative data.