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2019 Update of the American College of Rheumatology Recommended Rheumatoid Arthritis Disease Activity Measures


England BR1, Tiong BK2, Bergman MJ3, Curtis JR4, Kazi S5, Mikuls TR1, O'Dell JR1, Ranganath VK2, Limanni A6, Suter LG7, Michaud K8. Arthritis Care Res (Hoboken). 2019 Dec;71(12):1540-1555. doi: 10.1002/acr.24042. Epub 2019 Nov 11.

Author Information

1 VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha.

2 University of California, Los Angeles.

3 Drexel University, Philadelphia, Pennsylvania.

4 University of Alabama at Birmingham.

5 University of Texas Southwestern, Dallas.

6 Arthritis Centers of Texas, Dallas.

7 Yale University, New Haven, Connecticut, and VA Medical Center, West Haven, Connecticut.

8 University of Nebraska Medical Center, Omaha, and FORWARD, the National Databank for Rheumatic Diseases, Wichita, Kansas.



To provide updated American College of Rheumatology (ACR) recommendations on rheumatoid arthritis(RA) disease activity measurements to facilitate a treat-to-target approach in routine clinical care.


A working group conducted a systematic literature review from the time of the prior ACR recommendations literature search. Properties of disease activity measures were abstracted, and study quality was assessed using the Consensus-Based Standards for the selection of Health Measurement Instruments 4-point scoring method, allowing for overall level of evidence assessment. Measures that fulfilled a minimum standard were identified, and through a modified Delphi process preferred measures were selected for regular use in most clinic settings.


The search identified 5,199 articles, of which 110 were included in the review. This search identified 46 RA disease activity measures that contained patient, provider, laboratory, and/or imaging data. Descriptions of the measures, properties, study quality, level of evidence, and feasibility were abstracted and scored. Following a modified Delphi process, 11 measures fulfilled a minimum standard for regular use in most clinic settings, and 5 measures were recommended: the Disease Activity Score in 28 Joints with Erythrocyte Sedimentation Rate or C-Reactive Protein Level, Clinical Disease Activity Index, Simplified Disease Activity Index, Routine Assessment of Patient Index Data 3, and Patient Activity Scale-II.


We have updated prior ACR recommendations for preferred RA disease activity measures, identifying 11 measures that met a minimum standard for regular use and 5 measures that were preferred for regular use in most clinic settings.