- How do you feel: better or worse? This is your personal opinion and is a subjective measure. Your doctor may ask you to fill out a written questionnaire about how you're feeling.
- Do you look and sound better? This is your doctor's opinion, based on what he or she can see, and is also a subjective measure.
- What do your blood tests show? Blood tests will be done to look for signs of treatment side effects and to check your erythrocyte sedimentation rate (ESR) and/or your C-reactive protein (CRP) levels to see whether the inflammation in your body is being reduced. This is an objective measure of disease.
- How do your joints look? Your rheumatologist may schedule imaging (x-ray, MRI, CT scan, or ultrasound) to see what effect treatment is having on joint damage and erosion. This objective measure is referred to as monitoring the radiographic progression of rheumatoid arthritis. It's a term that's useful to understand because it's frequently used during treatment.
There are many questionnaires and scoring systems that may be used to help monitor treatment. They work by assigning points to the results from the questions above: the amount of swelling and tenderness observed in your joints, your blood test results, your answers about how you feel, and the radiographic progression seen on your x-rays. The points are then calculated to come up with a number. It's this number that your rheumatologist is aiming to move toward your target -- or remission -- number.
If your treatment plan isn't moving you toward your remission number, your rheumatologist will likely adjust your therapy, which may involve increasing dosages, adding a drug, or switching to a different medication. This process is called treating toward a target, intensive therapy, or aggressive therapy, and it is the most effective way to treat rheumatoid arthritis.