TY - JOUR T1 - Are Physician-derived Joint Counts Obsolete? JF - The Journal of Rheumatology JO - J Rheumatol SP - 883 LP - 884 DO - 10.3899/jrheum.100242 VL - 37 IS - 5 AU - EDWARD C. KEYSTONE Y1 - 2010/05/01 UR - http://www.jrheum.org/content/37/5/883.abstract N2 - In rheumatoid arthritis (RA) it is clear that persistent synovitis leads to joint destruction and disability. Currently, the goal in the treatment of RA is to achieve remission both clinically and radiographically. Remission implies the absence of synovitis as assessed by the absence of tender and swollen joints clinically, lack of radiographic progression, and a normal acute-phase reactant (APR). In this context, the tender (TJC) and swollen joint counts (SJC) are central to the clinical assessment of synovitis1,2. The importance of joint counts as a measure of synovitis is seen by their prominence in the 2 major clinical composite indices, the American College of Rheumatology (ACR) and European Disease Activity Score (DAS). In the ACR index the TJC and SJC must improve by 20%, 50%, or 70% to achieve an ACR20, 50, and 70 response, respectively, regardless of improvement in 3 of the other 5 core set measures. In the DAS score, the TJC and SJC constitute 2 of the 4 outcome measures. The TJC and SJC together contribute numerically to ~50% of the score.Despite the importance of the TJC and SJC to both clinical and radiographic outcomes, the tendency among rheumatologists is to do less frequent assessment of joint counts. Thus, a recent report has shown that formal quantitative joint counts by rheumatologists are carried out in a minority of patients3. Coupled with the trend to use patient-derived outcomes exclusively as a measure … Address correspondence to Dr. Keystone; E-mail: EKeystone{at}mtsinai.on.ca ER -