Functional disability

The Stanford Health Assessment Questionnaire (HAQ) (Fries et al., 1980; Wolfe, 2004), the

Arthritis Impact Measurement Scale (AIMS) (Meenan et al., 1980), and the Medical Outcomes Survey Short-Form (SF-36) (Ware et al., 1992) are the three most frequently used questionnaires in RA.

8.3. Radiographic assessment

Radiographic damage is considered to be the 'gold standard' for assessment of outcome and is used in clinical trials as primary outcome or end point. In general, radiographs of hands and/or feet are used since they include the joints affected earliest and may be a good measure of general joint damage. The two most commonly used radiographic scores are the Sharp score (Sharp et al., 1971) and the Larsen score (Larsen et al., 1977). A number of modifications of these methods have been published (van der Heijde et al., 1992; Larsen 1995; Genant, 1983). Recently, an MRI imaging score (Bird et al., 2005) and an ultrasonographic (US) synovitis scoring system (Scheel et al., 2005) have been proposed especially to score early synovitis.

8.4. Indices

Indices of disease activity such as the disease activity score (DAS) are being developed to combine disease activity measures into a single expression of disease activity (van der Heijde et al., 1990). Also available are the mathematical modifications to the DAS, namely the DAS28 (based on 28-joint counts) and the DAS28-CRP (i.e. the DAS28 using CRP instead of ESR) (Prevoo et al., 1995), and the recently introduced Simplified Disease Activity Index (SDAI) (Smolen et al., 2003). Other indices evaluate efficacy of treatment in clinical trials (ACR-20 and EULAR response criteria) (Felson, 1995: van Gestel et al., 1996).

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