Assessment of rheumatoid arthritis activity and treatment with disease-modifying anti-rheumatic drugs in outpatients in routine clinical practice
https://doi.org/10.33667/2078-5631-2026-12-18-23
Abstract
Objective. To assess rheumatoid arthritis (RA) activity and the adequacy of ongoing conventional disease-modifying anti-rheumatic therapy in outpatients in real-world clinical practice. Materials and methods. A total of 115 outpatients with RA who consulted a rheumatologist were examined. Disease activity was assessed using the DAS 28-CRP index; the physician’s global assessment of activity, the ratio of tender to swollen joints, and the results of the HADS and FIRST questionnaires were also taken into account. The effectiveness of regular follow-up was analyzed. Results. According to DAS 28-CRP, remission/low disease activity was identified in 43.7 % of patients, moderate activity in 42.7 %, and high activity in 13.6 %. At the same time, objective signs of inflammatory activity (elevated CRP and ≥1 swollen joint) were observed in only 22.3 % of patients. In 34.0 % of patients, DAS 28 overestimated disease activity; this was associated with anxiety, depression, or fibromyalgia. Signs of at least one of these comorbid conditions were detected in 52.6 % of the patients examined. The effectiveness of regular follow-up was demonstrated: high RA activity was observed in 32.1 % of patients with irregular rheumatology visits, whereas among patients seen by a rheumatologist every 6 months or more frequently, high RA activity was recorded in 12.0 % (p=0.014). In 18.4 % of patients, the potential of basic therapy had not been fully exhausted. Conclusions. The DAS 28-CRP index may overestimate RA activity due to subjective factors; therefore, screening for anxiety, depression, and fibromyalgia appears advisable. Control of RA activity improves with regular patient follow-up, indicating the need to establish structured dispensary monitoring.
About the Authors
N. M. Ruslanova
Ural State Medical University
Russian Federation
Russian Federation
Ruslanova Nadezhda M., postgraduate student at Dept of Propaedeutics of Internal Medicine
L. P. Evstigneeva
Ural State Medical University; Sverdlovsk Regional Clinical Hospital № 1
Russian Federation
Russian Federation
Evstigneeva Lyudmila P., Dr Med Sci (habil.), associate professor at Dept of Outpatient Therapy; head of Dept of the Rheumatology, сhief external rheumatologist of the Ministry of Health of the Sverdlovsk Region.
References
1. Rheumatoid arthritis. Clinical guidelines. Ministry of Health of the Russian Federation, 2024. 120 p. (In Russ.). URL: https://cr.minzdrav.gov.ru/preview-cr/536_3 (access date: 15.01.2026).
2. Smolen J., Landewé R., Bergstra S. et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann Rheum Dis. 2023 Jan; 82 (1): 3–18. URL: https://pubmed.ncbi.nlm.nih.gov/36357155
3. England B., Tiong B., Bergman M. et al. 2019 Update of the American College of Rheumatology Recommended Rheumatoid Arthritis Disease Activity Measures. Arthritis Care Res (Hoboken). 2019 Dec; 71 (12): 1540–1555. URL: https://pubmed.ncbi.nlm.nih.gov/31709779
4. Lila A. M., Olyunin Yu.A., Gordeev A. V. Assessment of the status of patients with rheumatoid arthritis: current trends. Modern Rheumatology Journal. 2020; 14 (2): 7–13. (In Russ.). URL: https://cyberleninka.ru/article/n/otsenka-statusa-bolnyh-revmatoidnym-artritom-sovremennye-tendentsii/viewer
5. Pincus T., Schmukler J., Block J. et al. Should quantitative assessment of rheumatoid arthritis include measures of joint damage and patient distress, in addition to measures of apparent inflammatory activity? ACR Open Rheumatol. 2023 Jan; 5 (1): 49–50. URL: https://pmc.ncbi.nlm.nih.gov/articles/PMC9837390
6. Desthieux C., Hermet A., Granger B. Patient-Physician Discordance in Global Assessment in Rheumatoid Arthritis: A Systematic Literature Review with Meta-Analysis. Arthritis Care Res (Hoboken). 2016 Dec; 68 (12): 1767–1773. URL: https://pubmed.ncbi.nlm.nih.gov/27059693
7. Nikiphorou E., Radner H., Chatzidionysiou K. et al. Patient global assessment in measuring disease activity in rheumatoid arthritis: a review of the literature. Arthritis Res Ther. 2016 Oct 28; 18 (1): 251. URL: https://pubmed.ncbi.nlm.nih.gov/27793211
8. Folomeeva O. M., Nasonov E. L., Andrianova I. A. et al. Rheumatoid arthritis in rheumatological practice in Russia: disease severity in the Russian patient population. A cross-sectional epidemiological study (RAISER). Scientific and Practical Rheumatology. 2010; 1: 50–60. (In Russ.). URL: https://cyberleninka.ru/article/n/revmatoidnyy-artrit-v-revmatologicheskoy-praktike-rossii-tyazhest-zabolevaniya-v-rossiyskoy-populyatsii-bolnyh-odnomomentnoe
9. Amirdzhanova V. N., Polishchuk E. Yu., Anoshenkova O. N., et al. Efficacy and safety of rapid dose escalation of methotrexate in rheumatoid arthritis (results of the multicenter study «METEOR»). Scientific and Practical Rheumatology. 2025; 63 (1): 55–64. (In Russ.). URL: https://cyberleninka.ru/article/n/effektivnost-i-bezopasnost-bystroy-eskalatsii-dozy-metotreksata-pri-revmatoidnom-artrite-rezultaty-mnogotsentrovogo-issledovaniya
10. Nasonov E. L., Karateev D. E., Satybaldyev A. M. et al. Rheumatoid arthritis in the Russian Federation according to the Russian Arthritis Registry (Report I). Scientific and Practical Rheumatology. 2015; 53 (5): 472–484. (In Russ.). URL: https://cyberleninka.ru/article/n/revmatoidnyy-artrit-v-rossiyskoy-federatsii-po-dannym-rossiyskogo-registra-bolnyh-artritom-soobschenie-i
11. Amirdzhanova V. N., Pogozheva E. Yu., Karateev A. E. et al. Rheumatoid arthritis in real clinical practice: initiation of therapy with genetically engineered biological drugs. Results of the project «Computer terminals for self-assessment of patients with rheumatic diseases» («TERMINAL–II»). Modern Rheumatology. 2019; 13. (3): 30–38. (In Russ.). URL: https://cyberleninka.ru/article/n/revmatoidnyy-artrit-v-realnoy-klinicheskoy-praktike-initsiatsiya-terapii-genno-inzhenernymi-biologicheskimi-preparatami-rezultaty
12. Bobkova A. O., Lila A. M., Karateev A. E. Predictors of ineffective therapy in patients with rheumatoid arthritis requiring bDMARDs/JAKi switching: data from a single-center prospective study. Terapevticheskii arkhiv. 2025; 97 (12): 973–980. (In Russ.). URL: https://journals.eco-vector.com/0040–3660/article/view/643411
13. Pincus T., Li T., Gibson K. Elevated DAS 28, CDAI, RAPID 3 and five of seven RA core data set measures in patients with positive screens for anxiety, depression or fibromyalgia on an MDHAQ. Rheumatology (Oxford). 2025 Aug 1; 64 (8): 4555–4564. URL: https://pubmed.ncbi.nlm.nih.gov/40156145
14. Melikova N. A., Filatova E. G., Lila A. M. Fibromyalgia in rheumatoid arthritis: characteristics of pain syndrome and its impact on disease activity and quality of life of patients. Modern Rheumatology. 2022; 16 (1): 32–37. (In Russ.). URL: https://cyberleninka.ru/article/n/fibromialgiya-pri-revmatoidnom-artrite-osobennosti-bolevogo-sindroma-vliyanie-na-aktivnost-zabolevaniya-i-kachestvo-zhizni
15. Prokofieva Yu.A., Musaeva L. M., Menshikova I. V. The role of timely monitoring of rheumatoid arthritis therapy effectiveness. Consilium Medicum. 2023; 25 (11): 788–792. (In Russ.). URL: https://cyberleninka.ru/article/n/rol-svoevremennogo-kontrolya-effektivnosti-terapii-revmatoidnogo-artrita
16. Matcham F., Rayner L., Steer S. et al. The prevalence of depression in rheumatoid arthritis: a systematic review and meta-analysis. Rheumatology (Oxford). 2013 Dec; 52 (12): 2136–48. DOI: 10.1093/rheumatology/ket169. Epub 2013 Sep 3. URL: https://pubmed.ncbi.nlm.nih.gov/24003249
17. Drakes D., Fawcett E., Yick J. et al. Beyond rheumatoid arthritis: A meta-analysis of the prevalence of anxiety and depressive disorders in rheumatoid arthritis. J Psychiatr Res. 2025 Apr; 184: 424–438. URL: https://pubmed.ncbi.nlm.nih.gov/40112611
18. Duffield S., Miller N., Zhao S. et al. Concomitant fibromyalgia complicating chronic inflammatory arthritis: a systematic review and meta-analysis. Rheumatology (Oxford). 2018 Aug 1; 57 (8): 1453–1460. URL: https://pubmed.ncbi.nlm.nih.gov/29788461
19. Pisaniello H., Whittle S., Lester S. et al. Using the derived 28-joint disease activity score patient-reported components (DAS 28-P) index as a discriminatory measure of response to disease-modifying anti-rheumatic drug therapy in early rheumatoid arthritis. BMC Rheumatol. 2022 Nov 15; 6 (1): 67. URL: https://pubmed.ncbi.nlm.nih.gov/36376988
20. Vermeer M., Kuper H., van der Bijl A. et al. The provisional ACR/EULAR definition of remission in RA: a comment on the patient global assessment criterion. Rheumatology (Oxford). 2012 Jun; 51 (6): 1076–80. URL: https://pubmed.ncbi.nlm.nih.gov/22302059
21. Devald I. V., Khodus E. A., Ignatova G. L. et al. Influence of Folic Acid Supplementation on the Efficacy and Tolerability of Different Forms of Methotrexate in Patients with Rheumatoid Arthritis. Continuous Medical Education and Science. 2023; 17 (4): 39–51. (In Russ.). URL: https://cmedas.elpub.ru/jour/article/view/19
22.
Review
For citations:
Ruslanova N.M., Evstigneeva L.P. Assessment of rheumatoid arthritis activity and treatment with disease-modifying anti-rheumatic drugs in outpatients in routine clinical practice. Medical alphabet. 2026;(12):18-23. (In Russ.) https://doi.org/10.33667/2078-5631-2026-12-18-23
Views:
49
JATS XML
Email this article 