Physician Estimate of Inflammation Global Assessment in Explaining Variations in Swollen Joint Counts in Rheumatoid Arthritis Patients

Overview

Journal Rheumatol Adv Pract

Publisher Oxford University Press

Specialty Rheumatology

Date 2024 May 27

PMID 38800575

Authors

Juan Schmukler

Tengfei Li

Theodore Pincus

Affiliations

Soon will be listed here.

Abstract

Objective: To analyse patients with RA for inflammatory activity by physician estimate of global assessment (DOCGL) an estimate of inflammatory activity (DOCINF) to explain variation in the swollen joint count (SJC).

Methods: Patients with RA were studied at routine care visits. Patients completed a multidimensional health assessment questionnaire (MDHAQ) and the physician completed a 28-joint count for swollen (SJC), tender (TJC) and deformed (DJC) joints and a RheuMetric checklist with a 0-10 DOCGL visual numeric scale (VNS) and 0-10 VNS estimates of inflammation (DOCINF), damage (DOCDAM) and patient distress (DOCSTR). The disease activity score in 28 joints with ESR (DAS28-ESR), Clinical Disease Activity Index (CDAI) and Routine Assessment of Patient Index Data 3 (RAPID3) were calculated. Individual scores and RA indices were compared according to Spearman correlation coefficients and regression analyses.

Results: A total of 104 unselected patients were included, with a median age and disease duration of 54.5 and 5 years, respectively. The median DAS28-ESR was 2.9 (Q1-Q3: 2.0-3.7), indicating low activity. DOCINF was correlated significantly with DOCGL (ρ = 0.775). Both DOCGL and DOCINF were correlated significantly with most other measures; correlations with DOCGL were generally higher than with DOCINF other than for SJC. In regression analyses, DOCINF was more explanatory of variation in SJC than DOCGL and other DAS28-ESR components.

Conclusions: Variation in SJC is explained more by a 0-10 DOCINF VNS than the traditional DOCGL or any other measure in RA patients seen in routine care. DOCINF on a RheuMetric checklist can provide informative quantitative scores concerning inflammatory activity in RA patients monitored over long periods.

Citing Articles

Physician estimates of inflammation, damage and distress in rheumatoid arthritis: how can they be used to improve patient care?.

Doumen M, De Meyst E, Verschueren P Rheumatol Adv Pract. 2024; 8(3):rkae072.

PMID: 38912422 PMC: 11190043. DOI: 10.1093/rap/rkae072.

References

Morla R, Li T, Castrejon I, Luta G, Pincus T . Multidimensional Health Assessment Questionnaire as an Effective Tool to Screen for Depression in Routine Rheumatology Care. Arthritis Care Res (Hoboken). 2020; 73(1):120-129. DOI: 10.1002/acr.24467. View

Sokka T, Pincus T . Erythrocyte sedimentation rate, C-reactive protein, or rheumatoid factor are normal at presentation in 35%-45% of patients with rheumatoid arthritis seen between 1980 and 2004: analyses from Finland and the United States. J Rheumatol. 2009; 36(7):1387-90. DOI: 10.3899/jrheum.080770. View

Boers M, Tugwell P, Felson D, van Riel P, Kirwan J, Edmonds J . World Health Organization and International League of Associations for Rheumatology core endpoints for symptom modifying antirheumatic drugs in rheumatoid arthritis clinical trials. J Rheumatol Suppl. 1994; 41:86-9. View

Islam S, Descallar J, Martens D, Hassett G, Gibson K . Screening for Anxiety in Patients With Inflammatory Arthritis Using the Multidimensional Health Assessment Questionnaire. J Rheumatol. 2023; 50(10):1273-1278. DOI: 10.3899/jrheum.2022-1261. View

Gibson K, Castrejon I, Descallar J, Pincus T . Fibromyalgia Assessment Screening Tool: Clues to Fibromyalgia on a Multidimensional Health Assessment Questionnaire for Routine Care. J Rheumatol. 2019; 47(5):761-769. DOI: 10.3899/jrheum.190277. View

Strand V, Cohen S, Crawford B, Smolen J, Scott D . Patient-reported outcomes better discriminate active treatment from placebo in randomized controlled trials in rheumatoid arthritis. Rheumatology (Oxford). 2004; 43(5):640-7. DOI: 10.1093/rheumatology/keh140. View

Pincus T, Schmukler J, Block J, Goodson N, Yazici Y . Should quantitative assessment of rheumatoid arthritis include measures of joint damage and patient distress, in addition to measures of apparent inflammatory activity?. ACR Open Rheumatol. 2022; 5(1):49-50. PMC: 9837390. DOI: 10.1002/acr2.11514. View

Fuchs H, Brooks R, Callahan L, Pincus T . A simplified twenty-eight-joint quantitative articular index in rheumatoid arthritis. Arthritis Rheum. 1989; 32(5):531-7. DOI: 10.1002/anr.1780320504. View

Harrington J . The uses of disease activity scoring and the physician global assessment of disease activity for managing rheumatoid arthritis in rheumatology practice. J Rheumatol. 2009; 36(5):925-9. DOI: 10.3899/jrheum.081046. View

10.

van der Heijde D, van t Hof M, van Riel P, van de Putte L . Development of a disease activity score based on judgment in clinical practice by rheumatologists. J Rheumatol. 1993; 20(3):579-81. View

11.

Pincus T, Richardson B, Strand V, Bergman M . Relative efficiencies of the 7 rheumatoid arthritis Core Data Set measures to distinguish active from control treatments in 9 comparisons from clinical trials of 5 agents. Clin Exp Rheumatol. 2014; 32(5 Suppl 85):S-47-54. View

12.

Ruiz-Medrano E, Espinosa-Ortega H, Arce-Salinas C . The effect of concomitant hand osteoarthritis on pain and disease activity in patients with rheumatoid arthritis. Clin Rheumatol. 2019; 38(10):2709-2716. DOI: 10.1007/s10067-019-04574-6. View

13.

Pincus T, Swearingen C, Wolfe F . Toward a multidimensional Health Assessment Questionnaire (MDHAQ): assessment of advanced activities of daily living and psychological status in the patient-friendly health assessment questionnaire format. Arthritis Rheum. 1999; 42(10):2220-30. DOI: 10.1002/1529-0131(199910)42:10<2220::AID-ANR26>3.0.CO;2-5. View

14.

Klinkhoff A, Bellamy N, Bombardier C, Carette S, Chalmers A, Esdaile J . An experiment in reducing interobserver variability of the examination for joint tenderness. J Rheumatol. 1988; 15(3):492-4. View

15.

Felson D, Anderson J, Boers M, Bombardier C, Furst D, Goldsmith C . American College of Rheumatology. Preliminary definition of improvement in rheumatoid arthritis. Arthritis Rheum. 1995; 38(6):727-35. DOI: 10.1002/art.1780380602. View

16.

Castrejon I, Bergman M, Pincus T . MDHAQ/RAPID3 to recognize improvement over 2 months in usual care of patients with osteoarthritis, systemic lupus erythematosus, spondyloarthropathy, and gout, as well as rheumatoid arthritis. J Clin Rheumatol. 2013; 19(4):169-74. DOI: 10.1097/RHU.0b013e3182936b98. View

17.

Pincus T, Swearingen C, Bergman M, Colglazier C, Kaell A, Kunath A . RAPID3 (Routine Assessment of Patient Index Data) on an MDHAQ (Multidimensional Health Assessment Questionnaire): agreement with DAS28 (Disease Activity Score) and CDAI (Clinical Disease Activity Index) activity categories, scored in five versus.... Arthritis Care Res (Hoboken). 2010; 62(2):181-9. DOI: 10.1002/acr.20066. View

18.

Fries J, Spitz P, Kraines R, HOLMAN H . Measurement of patient outcome in arthritis. Arthritis Rheum. 1980; 23(2):137-45. DOI: 10.1002/art.1780230202. View

19.

Sokka T, Pincus T . Joint counts to assess rheumatoid arthritis for clinical research and usual clinical care: advantages and limitations. Rheum Dis Clin North Am. 2009; 35(4):713-22, v-vi. DOI: 10.1016/j.rdc.2009.10.004. View

20.

Pope J, Michaud K . Is It Time to Banish Composite Measures for Remission in Rheumatoid Arthritis?. Arthritis Care Res (Hoboken). 2019; 71(10):1300-1303. DOI: 10.1002/acr.23862. View