engleski

Comparison of the Count of Tender and Swollen Joints by Self- Assessment and Assessment by a Physician in Patients with Rheumatoid Arthritis – Results from a Single Tertiary Care Centre in Croatia

Background. Systematic assessment of swelling and tenderness in joints has become a standard measure of disease activity and therefore joint counts are included in generally accepted composite measures of disease activity in rheuma¬toid arthritis (RA). Self-reported outcomes have become central to the measure¬ment of response to treatment both in clinical trials and in the routine practice. Objectives. The aim of our study was to evaluate whether patients with RA can reliably report on joint tenderness and swelling and to correlate it with the assess¬ment performed by a trained physician. Methods. Consecutive patients with established diagnosis of RA (n= 82 ; 73 women, 9 men) from the University Department were asked to assess their num¬ber of swollen and tender joints and the same was performed by a trained physi¬ cian. A 28 standard joint set (shoulder, elbow, wrist, MCP, PIP, knee ; on both sides) was used with a help of visual presentation (mannequin). Following data were also obtained: age, gender, education level, Patient’s Global Assessment (PtGA), Physician’s Global Assessment (PhGA), CRP, level of pain (on 100mm horizontal VAS), duration of morning stiffness (in minutes), Disease Activity Score 28 (DAS 28), Health Assessment Questionnaire (HAQ). Correlation with different variables was determined by Pearson’s correlation. The relationship be¬tween assessment of number of tender and swollen joints (dependent variables) and indicators of disease activity was determined separately for physician’s and patients’ assessments, by ANCOVA. Results. There was a significant positive correlation between the number of ten¬der joints determined by patients and physician (p<0.001) and also between the number of swollen joints determined by patients and physician (p<0.001). Sig¬nificant correlation was also found between the number of tender and swollen joints, determined either by physician or a patient, and DAS (p<0.001) and level of pain (p<0.001 tender joints ; p=0.03 swollen joints). We also analyzed which indicators of disease activity were related to physician’s and patients’ assessment of tender and swollen joints. When controlled for age, gender and patients’ level of education, morning stiffness was the only significant factor related to the num¬ber of tender and swollen joints determined by a physician. Conclusions. In our sample of patients with RA self-assessment of number of swollen and tender joints was in concordance with the count done by a trained physician. Morning stiffness, DAS and level of pain were significantly associated with the number of swollen and tender joints. Self-report tender and swollen joint count should be considered as a valuable and reliable alternative in assessing the disease activity in RA. Keywords. Assessment, count, joint, patient, physician, rheumatoid arthritis, self, swollen, tender.

( Assessment ; count ; joint ; patient ; physician ; rheumatoid arthritis ; self ; swollen ; tender)

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