How to plug the leaky pipeline in clinical rheumatology across Europe-lessons to be learned from experiences in business.

OBJECTIVES: While >50% of medical students and residents are women, their proportion drastically diminishes within higher ranks and leadership roles; this is known as the 'leaky pipeline'. We aimed to evaluate the leaky pipeline among rheumatologists across Europe and to assess determinants inducing rheumatologists to leave hospitals. METHODS: Experts in the field of economics developed a questionnaire with scientific focus on the leaky pipeline among rheumatologists, which was distributed electronically by national scientific societies of EULAR countries and by individual contacts. We performed common factor analysis, univariate t-tests and multivariate regression analyses to appraise our dataset. RESULTS: A total of 311 hospital-based rheumatologists from 23/45 EULAR countries (52.7% females, 47.3% males) answered the questionnaire. The presence of the leaky pipeline was evident for the entire sample. Of 64% female rheumatologists only 34.2% of departments' directors were female, with noteworthy regional differences. Female doctors reported higher intentions to leave their hospital (ß = 0.28, P < 0.05) and lower commitment towards their current organization (ß = -0.34, P < 0.05) when compared with males. Women reported lower levels of job satisfaction (ß = -0.26, P < 0.10), promotion justice (ß = -0.55, P < 0.01) and career perspectives (ß = -0.26, P < 0.10, one-tailed) than men, explaining their lower organizational commitment. CONCLUSION: Female rheumatologists perceive worse job opportunities and satisfaction than males. Many reasons for the leaky pipeline are beyond the control of organizations. Based on our results, organizations should be encouraged to reconsider and adjust their performance management practices to enable an equitable work environment.

[National consensus statement by the Austrian Societies for Rheumatology, Pulmonology, Infectiology, Dermatology and Gastroenterology regarding the management of latent tuberculosis and the associated utilization of biologic and targeted synthetic DMARDS (disease modifying antirheumatic drugs)]. / Consensus Statement der Österreichischen Gesellschaften für Rheumatologie und Rehabilitation, Pneumologie, Infektiologie, Dermatologie und Gastroenterologie zum Umgang mit latenter Tuberkulose bei Therapien mit biologischen oder "targeted synthetic" DMARDs ("disease modifying antirheumatic drugs").

This nationwide Austrian consensus statement summarizes the recommendations on the management of latent tuberculosis by treatment with biologic and targeted synthetic DMARDs. The essential questions with respect to screening and preventive treatment were discussed by experts from the disciplines of rheumatology, pneumology, infectious diseases, dermatology and gastroenterology, based on the available data, and then a joint consensus was formed by agreement. This involved a differentiated discussion on the various forms of treatment, and clear recommendations were formulated.

National consensus statement by the Austrian Societies for Rheumatology, Pulmonology, Infectiology, Dermatology and Gastroenterology regarding the management of latent tuberculosis and the associated utilization of biologic and targeted synthetic disease modifying antirheumatic drugs (DMARDs).

This publication provides a thorough analysis of the most relevant topics concerning the management of latent tuberculosis when using biologic and targeted synthetic Disease Modifying Antirheumatic Drugs (DMARDs) by a multidisciplinary, select committee of Austrian physicians. The committee includes members of the Austrian Societies for Rheumatology and Rehabilitation, Pulmonology, Infectiology, Dermatology and Gastroenterology. Consensus was reached on issues regarding screening and treatment of latent tuberculosis and includes separate recommendations for each biologic and targeted synthetic DMARD.

2022 update of the Austrian Society of Rheumatology and Rehabilitation nutrition and lifestyle recommendations for patients with gout and hyperuricemia.

BACKGROUND: Gout is the most frequent inflammatory joint disease in the western world and has a proven genetic background. Additionally, lifestyle factors like increasing life span and wealth, sufficient to excess nutritional status and a growing prevalence of obesity in the population, as well as e.g. alcohol consumption contribute to the rising incidence of hyperuricemia and gout. Apart from an adequate medication, medical advice on nutrition and lifestyle is an essential part of the management of gout patients, being at high risk of internal comorbidities. OBJECTIVE: In 2015, the ÖGR (Österreichische Gesellschaft für Rheumatologie und Rehabilitation) working group for osteoarthritis and crystal arthropathies already published nutrition and lifestyle recommendations for patients with gout and hyperuricemia. Since then, a multitude of literature has been published addressing this topic, what required an update. METHODS: First, the authors performed a hierarchical literature search to screen the meanwhile published literature. Also considering references of the first publication, the relevant literature was selected, and the 2015 recommendations were either kept as published, reformulated or newly produced. Finally, the evidence level and the level of agreement with each recommendation were added. RESULTS: Following this process, ten recommendations were generated instead of the initial nine. Like in the original publication, a colored icon presentation was provided to complement the written text. CONCLUSION: The Austrian nutrition and lifestyle recommendations for patients with gout and hyperuricemia were updated incorporating the most recent relevant literature, serving as education material for patients and updated information for physicians.

Response to SARS-CoV-2 vaccination in systemic autoimmune rheumatic disease depends on immunosuppressive regimen: a matched, prospective cohort study.

OBJECTIVE: To assess the humoral response to messenger RNA (mRNA) vaccine of patients with systemic autoimmune rheumatic disease (SARD) and the effect of immunosuppressive medication in a matched cohort study. METHODS: Patients with SARD were enrolled and matched 1:1 for sex and age with healthy control (HC) subjects. Differences in humoral response to two doses of an mRNA vaccine in terms of seroconversion rate (SCR) and SARS-CoV-2 antibody level between the two groups and the impact of treatment within patients with SARD were assessed. RESULTS: We enrolled 82 patients with SARD and 82 matched HC. SCR after the first dose was lower among the patient group than that of HC (65% compared with 100% in HC, p<0.0001) but levelled up after the second dose (94% vs 100%). After the second dose, SCR was lower for patients on combination disease-modifying antirheumatic drug (DMARD) therapy compared with all other groups (81% compared with 95% for monotherapy, p=0.01; 100% for both no DMARD therapy and HC, both p<0.0001). In addition, antibody levels after both doses were lower in patients compared with HC. We found that vaccination response was determined primarily by the number of DMARDs and/or glucocorticoids received, with patients receiving combination therapy (dual and triple therapy) showing the poorest response. CONCLUSIONS: Patients with SARD showed a good response after the second vaccination with an mRNA vaccine. However, the choice of immunosuppressive medication has a marked effect on both SCR and overall antibody level, and the number of different immunomodulatory therapies determines vaccination response.

Importance of the second SARS-CoV-2 vaccination dose for achieving serological response in patients with rheumatoid arthritis and seronegative spondyloarthritis.

OBJECTIVES: To assess the kinetics of humoral response after the first and second dose of messenger RNA (mRNA) vaccines in patients with inflammatory joint diseases compared with healthy controls (HC). To analyse factors influencing the quantity of the immune response. METHODS: We enrolled patients with rheumatoid arthritis (RA) and seronegative spondyloarthritis (SpA), excluding those receiving B-cell depleting therapies and assessed the humoral response to mRNA vaccines after the first and the second dose of the vaccine in terms of seroconversion rate and titre. We compared the results to a HC group and analysed the influence of therapies as well as other characteristics on the humoral response. RESULTS: Samples from 53 patients with RA, 46 patients with SpA and 169 healthy participants were analysed. Seroconversion rates after the first immunisation were only 54% in patients with inflammatory arthritis compared with 98% in the HC group. However, seroconversion rates were 100% in all groups after second immunisation. Patients developed reduced antibody titres after the first vaccination compared with HC, but there was no difference after the second dose. While disease modifying anti-rheumatic drug (DMARD) monotherapy did not affect antibody levels, seroconversion rates as well as titre levels were reduced in patients receiving a combination of DMARDs compared with HC. CONCLUSIONS: Patients with inflammatory joint diseases under DMARD therapy show impaired humoral responses to the first vaccine dose but excellent final responses to vaccination with mRNA vaccines. Therefore, the full course of two immunisations is necessary for efficient vaccination responses in patients with inflammatory arthritis under DMARD therapy.

Improving the measurement of oral health-related quality of life: Rasch model of the oral health impact profile-14.

OBJECTIVES: The 14-item Oral Health Impact Profile (OHIP-14) is the most frequently used instrument to measure oral health-related quality-of-life (OHRQoL) in adults. Despite its popularity, its psychometric properties have been predominantly investigated based on the classical test theory while the fundamental principles of measurement have not been fully assessed. Therefore, our aim was to investigate to what extent the OHIP-14 meets the fundamental requirments of measurements. METHODS: We used the Rasch model to explore person-item-targeting, unidimensionality, local independence of items, invariance (differential-item-functioning, DIF), and the order of thresholds between response-options in the German version OHIP-14. We used data from osteoarthritis patients because hand disabilities and joint pain might influence oral hygiene. Furthermore, osteoarthritis in the temporomandibular-joint directly affects oral functioning. RESULTS: Five-hundred sixteen patients were included (mean age 66.5 years [±10.2; ranging from 34 to 89]; 71.3% [368] females). The OHIP-14 median total score was 0 (interquartile-range from 0 to 4), indicating a right-skewed distribution because many patients reported good OHRQoL. The instrument was found unidimensional. However, there was strong evidence of local dependency, disordered thresholds between response-options, and age-related DIF for item 5. A revised scoring scheme with three instead of five answer-options in all items and eliminating two items resolving local dependency, the newly adapted OHIP-12, showed better reliability and item-fit to the Rasch model than the original OHIP-14. CONCLUSIONS: This study assesses, for the first time, the OHIP-14 in terms of fundamental principles of measurement and proposes an item-reduced OHIP-12 as a psychometrically more accurate version of the instrument. CLINICAL SIGNIFICANCE: The Rasch model is essential to ensure instruments' precision and clinical meaningfulness when measuring OHRQoL in clinical practice and research. The OHIP-12, derived from the OHIP-14 by deleting two items due to local dependency, with a revised scoring scheme for all items distinguishing three answer-options instead of five, represents a psychometrically improved version of the instrument.

Rheumatological care in rural areas : The Rheuma-Bus project 2018.

OBJECTIVE: To explore the medical care of individuals in rural areas during a public health awareness project on musculoskeletal disorders (MSD). METHODS: A tour bus was adapted to accommodate rheumatological consultations at widely accessible sites in 16 towns, providing individual medical advice with respect to MSD. The participating rheumatologists assessed the nature (e.g. inflammatory/non inflammatory), extent and duration of MSD and, where possible, made a tentative diagnosis and gave further advice on the course of action. In addition, age, sex and pre-existing care were recorded. All individuals were asked to assess their own severity of pain using a numeric ordinal scale from "no" (0) to "extreme" (10). RESULTS: A total of 647 individuals visited the service. Median current pain intensity was 5 (interquartile range [IQR] 3-6), mean 4.9 (standard deviation [SD] 2.3). Osteoarthritis was suspected in 381 clients (59.6%), inflammatory rheumatic disease in 247 (38.7%), and in 104 (16.3%) other diseases. 307 (50%) were treated by a GP, 95 (15.5%) were under orthopaedic care, 204 (33.2%) under rheumatological care and 81 (13.1%) under supervision of other specialists. 104 clients (17%) had never consulted a physician for their MSD symptoms before. 27 (4.2%) of all the clients had a newly detected inflammatory rheumatic disease and 62 (9.6%) patients with suspected inflammatory rheumatic disease were not under previous rheumatological care. CONCLUSION: The findings showed that there is still a lot of negligence in awareness and knowledge of rheumatic diseases, at least in rural areas.

Compliance of Primary Care Providers With Gout Treatment Recommendations-Lessons to Learn: Results of a Nationwide Survey.

Objectives: Gout is generally managed in the primary health care sector. Compliance of primary care physicians with gout management recommendations has been shown to be insufficient in the past. The primary aims of this study were to assess primary care providers' knowledge regarding gout and to determine if their treatment decisions are influenced by recommendations. Facing considerable variations in postgraduate training options in Austria, we secondly looked for possible knowledge differences between urban and rural areas and eastern and western parts of Austria. Methods: We conducted a survey among 343 primary care physicians in Austria, using a questionnaire consisting of 10 questions on acute, intercritical and general gout management. Gout treatment recommendations served as the therapeutic gold standard. Results: Of the 343 physicians surveyed, 336 completed the questionnaire, leading to a very high return rate of 98%. 289 (86%) physicians were aware of the agreed-upon SUA target (<6 mg/dl). 323 (96.1%) reported change of therapy in case of missing this target. 112 (33.3%) physicians voted for long term ULT. No geographical differences in knowledge regarding gout or its management were revealed, except that colchicine was rated as being a safe medication significantly more often in rural areas (p = 0.035) and in western Austria (p = 0.014). Conclusion: As opposed to former studies, gout knowledge among primary care physicians has improved - however, treatment patterns are still not fully concordant with gout recommendations. Our findings may help to better tailor future postgraduate training to improve primary care physicians' education in gout.

Depression: a common comorbidity in women with rheumatoid arthritis-results from an Austrian cross-sectional study.

OBJECTIVES: Previous research showed that depression is common in rheumatoid arthritis (RA). However, the prevalence very much depends on different assessment tools and sociocultural differences, respectively. The main study aim and research question was to investigate the proportion of depressive symptoms in Austrian female patients with RA. SETTING: A nationwide multicentre study with seven secondary care centres all over Austria (hospital-based rheumatological outpatient clinics and private practices). PARTICIPANTS: 319 patients with RA and 306 healthy controls (HCO), all female Caucasians, were asked to complete a Beck's Depression Inventory-Fast Screen (BDI-FS). Patients and HCO were ≥18 years. Patients had to fulfil the 2010 classification criteria for RA. In addition, disease activity, disability, medication, drinking of alcoholic beverages, smoking and occupational status were evaluated. PRIMARY AND SECONDARY OUTCOME MEASURES: A BDI-FS cut-off value of ≥4, per definition, indicates the presence of a depressive symptomatology. RESULTS: The return rate of questionnaires was high: 235/319 (73.7%) in patients with RA and 180/306 (58.8%), ending up with 392 complete questionnaires from 223 patients with RA (69.9%) and 169 HCO (55.2%). The BDI-FS was significantly higher in patients with RA (median BDI-FS 2 (IQR 0-4) vs median 1 (IQR 0-2) in HCO, p<0.001). BDI-FS scores from ≥4, which by definition indicate depression, were found in 29.6% of patients with RA and 12.4% of HCO (p<0.001). Depressive symptoms were strongly associated with disease activity (Clinical Disease Activity Index, p<0.001) and disability (Health Assessment Questionnaire, p<0.005). No association of depressive symptoms with age, alcohol consumption, smoking, occupational status or use of medication was found. CONCLUSIONS: One-third of female patients with RA showed depressive symptoms. Depression was significantly higher in female patients with RA than in female HCO and was strongly associated with disease activity and disability. It would be of interest to address the same question in male participants.

Immunosuppressives and biologics during pregnancy and lactation : A consensus report issued by the Austrian Societies of Gastroenterology and Hepatology and Rheumatology and Rehabilitation.

An increasing and early-onset use of immunosuppressives and biologics has become more frequently seen among patients with inflammatory bowel diseases (IBD) and rheumatic disorders. Many women in their childbearing years currently receive such medications, and some of them in an interdisciplinary setting. Many questions arise in women already pregnant or wishing to conceive with respect to continuing or discontinuing treatment, the risks borne by the newborns and their mothers and long-term safety. Together with the Austrian Society of Rheumatology and Rehabilitation, the IBD working group of the Austrian Society of Gastroenterology and Hepatology has elaborated consensus statements on the use of immunosuppressives and biologics in pregnancy and lactation. This is the first Austrian interdisciplinary consensus on this topic. It is intended to serve as a basis and support for providing advice to our patients and their treating physicians.

High Burden of Sexual Dysfunction in Female Patients with Rheumatoid Arthritis: Results of a Cross-sectional Study.

OBJECTIVE: To evaluate the effect of rheumatoid arthritis (RA) on impairing women's sexuality regarding motivation, activity, and satisfaction, and to assess the correlation of disease-related physical impairment within sexual functioning. METHODS: An anonymous survey among women with RA and healthy controls (HC) using standardized questionnaires, predominantly the Changes in Sexual Functioning Questionnaire-short form (CSFQ-14). In addition, disease activity, depression, and disability were evaluated. RESULTS: There were 319 questionnaires distributed to patients and 306 to HC. Of these, 235 patient questionnaires (73.7%) and 180 HC questionnaires (58.8%) were returned, of which 203 and 169 were completed, respectively. Of the patients with RA, 47.8% had a total CSFQ-14 score of ≤ 41, indicating female sexual dysfunction (FSD), as compared to 14.2% of HC (p < 0.0001). The median CSFQ-14 score was lower in patients with RA [42 points, interquartile range (IQR) 36-48] than in HC (49 points, IQR 44-54; p < 0.0001), resulting in an OR of 5.53 (95% CI 3.19-9.57; p < 0.0001). After adjustment for confounders, given a higher mean age of patients (55.2 ± 11.3 yrs) than HC (47.4 ± 11.8 yrs; p < 0.0001), the OR for FSD in patients with RA was still 3.04 (95% CI 1.61-5.75; p = 0.001). Neither the Health Assessment Questionnaire-Disability Index nor the Clinical Disease Activity Index was associated with FSD after adjustment. CONCLUSION: FSD apparently is highly prevalent in female patients with RA, affects all subdomains of sexual function, and is most likely underestimated in daily clinical practice. Of note, FSD could not be linked to disability or RA disease activity.

[Austrian 3e-recommendations for diagnosis and management of gout 2013]. / Österreichische 3e-Empfehlungen zu Diagnose und Management von Gicht 2013.

BACKGROUND: Gout is the most common inflammatory joint disease in the Western world, with increasing prevalence. Like former 3e-initiatives (Experts-Evidence-Education) dealing with other rheumatological problems, this initiative aimed at the development of international recommendations for the diagnosis and management of gout and hyperuricemia based on a systematic literature research. METHODS: In the participating countries 10 national questions were generated via a Delphi-process. These questions were collected and out of this pool 10 international questions were formulated. Afterwards a systematic literature research was performed. On that basis again first national and afterwards international recommendations were generated. RESULTS: On the basis of the available literature an Austrian expert panel developed 10 recommendations on diagnosis and management of gout and hyperuricemia. After publication of the international 3e-recommendations we hereby present the national Austrian questions and expert-recommendations for diagnosis and management of gout 2013 followed by a comparison of the Austrian and the international recommendations.

Remission in rheumatoid arthritis: a comparison of the 2 newly proposed ACR/EULAR remission criteria with the rheumatoid arthritis disease activity index-5, a patient self-report disease activity index.

OBJECTIVE: We analyzed whether a patient self-report remission criterion, such as that according to the Rheumatoid Arthritis Disease Activity Index-5 (RADAI-5), meets the criteria of the 2011 proposed American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) definition of remission. METHODS: The 2 approaches of the ACR/EULAR proposal [Boolean- and Simplified Disease Activity Index (SDAI)-based] as well as the RADAI-5 were used to assess whether patients with RA are in remission. Sensitivity, specificity, positive and negative predictive values (PPV, NPV), and kappa analyses were performed to illustrate the relationship among the different approaches defining remission at a group level. RESULTS: In total, 705 patients' assessments were included. Eighty-nine patients were classified as being in remission according to the Boolean-based and 169 according to the SDAI-based definition of the ACR/EULAR proposals, and 154 according to the RADAI-5. Sixty-eight assessments were classified as being in remission according to all 3 definitions. In the case of RADAI-5 remission, sensitivity was 78%, specificity 86%, PPV 45%, and NPV 96%, indicating remission according to the Boolean-based definition; and 60%, 92%, 66%, and 90%, respectively, indicating remission according to the SDAI-based definition. In the case of remission according to the SDAI-based ACR/EULAR definition, sensitivity was 52%, specificity 100%, PPV 98%, and NPV 87%, also indicating remission according to the Boolean definition; while according to the Boolean definition the values were 98%, 87%, 52%, and 100%, respectively. Kappa statistics showed fair to good agreement for all 3 definitions. CONCLUSION: Nearly twice as many assessments were classified as being in remission using the SDAI-based or the RADAI-5 definitions when compared to the Boolean-based definition. Remission according to the RADAI-5 also was highly specific for both ACR/EULAR criteria. Sensitivity for the RADAI-5 criterion was even better for the Boolean-based definition than that for the SDAI-based definition.

Radiological aspects of osteoarthritis.

Osteoarthritis (OA) is one of the most frequent indications in musculoskeletal imaging because OA is the most prevalent musculoskeletal disease in developed countries. As the population becomes older and older, the need for adequate imaging techniques also increases. The various forms of osteoarthritis are associated with a high degree of illness-induced physical disability and reduced life quality. In some forms, the pathogenesis is complex and can require the discrimination of a variety of predisposing diseases. The specific forms of osteoarthritis will be highlighted in this article. In addition, the value of each imaging modality will be assessed, with special regard to the most common sites: hand, hip, and knee.

Does a special relationship between personality and rheumatoid arthritis exist? Experiences with an Austrian Psychological Questionnaire.

The aim of this study was to investigate whether the personalities of rheumatoid arthritis (RA) differ from those of non-rheumatologic patients. For the purpose of this study, the authors designed a psychological questionnaire, compiling relevant questions and impressions of several psychological questionnaires. A total of 226 patients (113 RA patients and 113 control persons (CO)) were asked to fill in the questionnaire assessing their psychological profile as well as demographic data on their family history. The control group consisted of healthy controls as well as scarcely affected individuals and chronically ill patients. The questionnaire was completed without any problems by 98% of patients. No statistical difference in any of the 26 questions was to be observed. Only the question concerning sibship revealed a trend towards single childhood in the RA group (p = 0.07). No differences between patients suffering from early RA and those in a later stage of the disease were revealed. There was no difference in the psychological profile of RA and CO detectable nor did disease duration or disability have an impact on the questionnaire's outcome. An interesting finding was the higher prevalence of single children in the RA group, although this difference did not reach statistical significance. This topic seems to be worth being addressed in a larger cohort of patients.

A comparison of patient questionnaires and composite indexes in routine care of rheumatoid arthritis patients.

OBJECTIVE: To evaluate the agreement between the Routine Assessment of Patient Index Data 3 (RAPID-3) and a modified version of the Rheumatoid Arthritis Disease Activity Index (RADAI-5), as well as the Disease Activity Score including a 28 joint count (DAS28-ESR) and the Clinical Disease Activity Index (CDAI) in daily routine. METHODS: One hundred and twenty-eight rheumatoid arthritis (RA) out-patients completed the RADAI-5 and the RAPID-3. Simultaneously, the DAS28-ESR and the CDAI were applied. Cronbach's Alpha as a measure for reliability was calculated and factorial analysis was performed. For agreement analysis, Kendall's Tau was calculated. RESULTS: Time to score the questionnaires was 25seconds. The median RADAI-5 was 2.8 (0-9.2), the median RAPID-3 3.3 (0-8.6), the median DAS28-ESR 2.95 (0.43-6.24), and the median CDAI 5.6 (0-37.5). Cronbach's Alpha for the RADAI-5 was 0.906 and 0.871 for the RAPID-3, however, only 0.165 for the DAS28-ESR and 0.210 for the CDAI, respectively. Factorial analysis revealed that both questionnaires and the DAS28-ESR, but not the CDAI, constitute mono-dimensional instruments. Tau for the agreement between the RADAI-5 and the RAPID-3 appeared to be 0.587 (p<0.001), and to be 0.582 (p<0.001) between the DAS28-ESR and the CDAI, while it was lower for the relationship between the questionnaires and the composite indexes. CONCLUSION: Reliability of the RAPID-3 and RADAI-5 was significantly higher than of the indexes. The questionnaires as well as the indexes proved to be in highly moderate agreement, while agreement between the questionnaires and the indexes appeared to be lower.

The rheumatoid arthritis disease activity index-5 in daily use. Proposal for disease activity categories.

OBJECTIVE: To establish thresholds for rheumatoid arthritis (RA) activity categories according to the RA Disease Activity Index-5 (RADAI-5). METHODS: Three hundred ninety-two patients with RA were categorized according to Disease Activity Score 28-joint count (DAS28), Clinical Disease Activity Index (CDAI), and their satisfaction (PATSAT) with disease status. These measures built the basis for the calculation of disease activity limits for the RADAI-5. Patient assessments simultaneously meeting the identical DAS28, CDAI, and PATSAT categories were taken as the references to establish the thresholds for the respective RADAI-5 categories by calculating the third quartile of the corresponding RADAI-5 values. Subsequently, these new thresholds were applied to all assessments. RESULTS: Seven hundred fifty-eight assessments in 392 patients (2 assessments median/patient) could be obtained, most patients having mild to moderate disease according to DAS28 and CDAI. Calculating the third quartile, the RADAI-5 thresholds were as follows: 0.0-1.4 for a remission-like state, 1.6-3.0 for mild disease activity, 3.2-5.4 for moderate, and 5.6-10.0 for high disease activity. Categorization according to the RADAI-5 showed a normal distribution, while DAS28 and CDAI were somewhat shifted to the left. DAS28 and CDAI levels, as well as tender and swollen joint counts and physician's global assessment and erythrocyte sedimentation rate, proved to be highly significantly different within the different RADAI-5 categories (Kruskal-Wallis test p < 0.001). CONCLUSION: RADAI-5 thresholds for RA activity could be elaborated. Patient self-report questionnaires may substitute composite disease activity scores and may contribute significantly to improving documentation in routine patient care.