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GERALD LEVY, CRAIG CHEETHAM, ALLISON CHEATWOOD, and RAOUL BURCHETTE

ABSTRACT.

Objective. To demonstrate the effectiveness of simple training on improving the ability of patients with rheumatoid arthritis (RA) to assess joint swelling, and to validate the use of a computerized questionnaire, the Health Assessment Questionnaire (HAQ-ulous), to collect patient-reported tender and swollen joint counts.

Methods. Sixty patients completed the HAQ-ulous, reporting pain and swelling of the 28 joints included in the Disease Activity Score-28. A rheumatologist blinded to the patients' responses assessed each joint for the presence of tenderness and swelling. At followup visits, 30 patients received training in distinguishing a swollen joint from a chronically enlarged joint, completed the HAQ-ulous again, and were reassessed by the physician.

Results. At the initial visit, a strong correlation was shown between patient- and clinician-reported tender joints [Pearson correlation coefficient (r_p) = 0.79; p < 0.0001]. Correlation between patient- and clinician-reported swollen joints was less robust (r_p = 0.41; p = 0.001). Following training at the second visit, agreement between patients and the clinician improved for both tender joints (r_p = 0.94; p < 0.0001) and swollen joints (r_p = 0.93; p < 0.0001).

Conclusion. With simple training in distinguishing swollen joints from chronically enlarged joints, the majority of patients are able to accurately assess joint swelling. Objective tools, such as the HAQ-ulous, that incorporate patient-reported outcomes are a valuable and reliable addition to standard clinical practice for monitoring patients with RA. (First Release April 15 2007; J Rheumatol 2007;34:1261-5)

Key Indexing Terms:

RHEUMATOID ARTHRITIS
SELF-ASSESSMENT
TRAINING
JOINT COUNTS
HEALTH ASSESSMENT QUESTIONNAIRE
DISEASE ACTIVITY SCORE

From the Department of Rheumatology, Southern California Kaiser Permanente, Bellflower, California, USA.

Supported by funding from the Regional Research Committee of Southern California Kaiser Permanente.

G.D. Levy, MD, MBA, Rheumatologist, Southern California Permanente Medical Group; C.T. Cheetham, PharmD, MS, Pharmacist, Pharmacy Analytical Service; A.P. Cheatwood, MS, Research Assistant, Department of Rheumatology; R.J. Burchette, MA, MS, Data Consultant, Research and Evaluation, Southern California Kaiser Permanente.

Address reprint requests to Dr. G.D. Levy, Department of Rheumatology, Kaiser Permanente, 9449 East Imperial Hwy, Downey, CA 90242. E-mail: gerald.d.levy@kp.org

Accepted for publication January 10, 2007.