Which of the following modalities represents the most useful indicator of the severity of disease in a rheumatoid arthritis sufferer?

c. This question is included to remind the clinician that the management of disease should always remain with the patient as a central focus. The indicators specified may all be associated with disease activity, although the role of early involvement of biological agents is currently being evaluated. Subjectively from a patient’s perspective the useful function that is managed comfortably in rheumatoid arthritis is the best indicator of disease activity. Appearances are often deceiving with ‘normal’ radiographs disguising disabling pain and loss of function whilst long-term deformities of the hands may mask surprising dexterity and adaptation.