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Patient Self-Administered Joint Tenderness Counts in Rheumatoid Arthritis Are Reliable and Responsive to Changes in Disease Activity

FERNANDO FIGUEROA, YOLANDA BRAUN-MOSCOVICI, DINESH KHANNA, ECHING VOON, LY GALLARDO, DONNA LUINSTRA, XIOMARA PINA, GRETCHEN HENSTORF, SANDY LAURENCE, RICHARD NEIMAN, and DANIEL FURST

ABSTRACT.

Objective. To examine whether self-assessment of tender and swollen joints by patients with rheumatoid arthritis (RA) can be used to evaluate changes in disease activity instead of joint counts by physicians.

Methods. Eighty-two patients with RA taking part in controlled studies were recruited for investigation. The patient's self-assessment of joint tenderness and swelling was completed both before and 30 minutes after examination by a physician. Examinations of tender and swollen joints by a rheumatologist were performed at baseline and 3 months later. The correlations and verification of agreement of these clinical assessments were analyzed.

Results. Within-patient and patient-physician correlations for joint tenderness counts were high (r = 0.96 and 0.78, respectively). Patient-physician correlation for joint swelling counts was still significant, although much lower (r = 0.34). Patients' and physicians' estimations of the change in disease activity over 3 months did not differ (p > 0.76 for all comparisons).

Conclusion. Joint tenderness counts were consistent when comparing intra-patient and patient–physician assessments, while joint swelling counts were poorly correlated. Patient and physician assessments of change over 3 months were parallel and similar for joint tenderness count. Self-administered tender joint counts might be a useful tool to evaluate the response to therapy in RA. (First Release Nov 1 2006; J Rheumatol 2007;34:54–6)

Key Indexing Terms:

RHEUMATOID ARTHRITIS
DISEASE ACTIVITY
SELF-ASSESSMENT

JOINT COUNT
OUTCOME MEASURES


From the Department of Medicine, Universidad de los Andes, Santiago de Chile, Chile; Department of Rheumatology, Rambam Medical Center, Technion, Haifa, Israel; Division of Immunology, Section of Rheumatology, University of Cincinnati, Cincinnati, Ohio, USA; and Department of Rheumatology, University of California at Los Angeles, Los Angeles, California, USA.

F.E. Figueroa, Professor of Medicine, Facultad de Medicina, Universidad de los Andes; Y. Braun-Moscovici, MD, B. Rappaport Faculty of Medicine, Rambam Medical Center; D. Khanna, MD, Assistant Professor of Medicine, University of Cincinnati; E. Voon, Physician Assistant, University of Washington Medical Center; L. Gallardo, BS; D. Luinstra, BS, MBA; X. Pina, BA; G. Henstorf, BA, CCRC, Fred Hutchinson Cancer Research Center, Seattle, Washington; S. Laurence, CMA; R. Neiman, MD; D.E. Furst, MD, Professor of Rheumatology, University of California at Los Angeles.

Address reprint requests to Dr. D.E. Furst, Department of Rheumatology, University of California at Los Angeles, Room 32-59, 1000 Veteran Ave., Los Angeles, CA 90095-1670. E-mail: defurst@mednet.ucla.edu

Accepted for publication August 17, 2006.




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© 2007. The Journal of Rheumatology Publishing Company Limited. All rights reserved.