Quality statement 5: Disease control

Quality statement

People who have active rheumatoid arthritis have their C-reactive protein (CRP) and disease activity measured monthly in specialist care until they are in remission or have low disease activity.

Rationale

Regular monitoring of CRP and disease activity allows for dose escalation of disease-modifying anti-rheumatic drugs (DMARDs). It is also important for checking the need for short-term bridging treatment with glucocorticoids and whether people are tolerating the drug regimen, assessing for side effects, providing support and encouraging adherence.

Quality measure

Structure: Evidence of local arrangements to ensure that people with active rheumatoid arthritis have their CRP and disease activity measured monthly in specialist care until they are in remission or have low disease activity.

Process:
a) Proportion of people with active rheumatoid arthritis who have their CRP and disease activity measured monthly.

Numerator – the number of people in the denominator who have their CRP and disease activity measured monthly.

Denominator – the number of people with active rheumatoid arthritis.

b) Proportion of people with previously active rheumatoid arthritis, who had their CRP and disease activity measured monthly in specialist care until they were in remission or had low disease activity.

Numerator – the number of people in the denominator who had their CRP and disease activity measured monthly in specialist care until they were in remission or had low disease activity.

Denominator – the number of people with previously active rheumatoid arthritis, who are currently in remission or have low disease activity.

Outcome:
a) Controlled rheumatoid arthritis.

b) Functional ability.

What the quality statement means for each audience

Service providers ensure systems are in place for people with active rheumatoid arthritis to have their CRP and disease activity measured monthly in specialist care until they are in remission or have low disease activity.

Healthcare professionals ensure that people with active rheumatoid arthritis have their CRP and disease activity measured monthly in specialist care until they are in remission or have low disease activity.

Commissioners ensure they commission services that enable people with active rheumatoid arthritis to have their CRP and disease activity measured monthly in specialist care until they are in remission or have low disease activity.

People with active rheumatoid arthritis have their disease activity monitored every month in specialist care until they are in remission or have low disease activity.

Source guidance

Rheumatoid arthritis in adults: management (2018) NICE guideline NG100, recommendation 1.2.3

Data source

Structure: Local data collection.

Process:
a) and b) Local data collection. Contained within the Commissioning for Quality in Rheumatoid Arthritis (CQRA) Patient metric data collection form for recent onset rheumatoid arthritis.

Outcome:
a) and b) Local data collection.

Definitions

Remission (for example, a DAS28 score of less than 2.6) is the most appropriate target for most people. For those who are unable to achieve remission despite a treat-to-target approach with appropriate escalation, low disease activity (for example, a DAS28 score of less than 3.2) is an acceptable target.