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Standardising joint assessment in rheumatoid arthritis

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Summary

Evaluating joint involvement in rheumatoid arthritis in a key clinical assessment. We investigated the extent of variation in measurement of joint swelling and tenderness and evaluated the impact of training to standardise methods. Eight observers (medical and nursing staff) examined eight rheumatoid patients for joint swelling and tenderness before and after training in clinical methods. The EULAR handbook for joint evaluation was used for training and assessments were based on the 28 joint count. There was extensive variability in both numbers of swollen and tender joints. Coefficients of variation for articular indices recorded by the 8 observers in individual patients were often high (up to a maximum of 204%), indicating considerable differences between observers. Training had an impact on the assessment of the numbers of swollen joints which increased by a mean of 32% (P<0.05) and the number of tender joints which increased by 41% (p<0.01). Training had only a limited impact on the variation among observers in determining the number of swollen and number of tender joints. After training, the mean coefficients of variation were still 59% for swollen joints and 65% for tender joints. These results highlight the extent of variation in clinical assessment of rheumatoid arthritis and show the advantages of training. It leads to increased sensitivity of measurement. Standardisation appears essential for clinical studies.

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References

  1. Tugwell, P., Boers, M. OMERACT conference on outcome measures in RA clinical trials: conclusion. J Rheumatol 1993, 20, 590–594.

    Google Scholar 

  2. van Riel, P.L.C.M. Provisional guidelines for measuring disease activity in RA clinical trials. Br J Rheumatol 1992, 31, 793–794.

    PubMed  Google Scholar 

  3. Scott, D.L., van Riel, P.L., van der Heijde, D., Benke, A.S. Assessing disease activity in rheumatoid arthritis. The EULAR handbook of standard methods, The EULAR Standing Committee for International Clinical Studies, 1993.

  4. Arnett, F.C., Edworthy, S.M., Bloch, D.A., et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988, 31, 315–324.

    PubMed  Google Scholar 

  5. Prevoo, M.L., van Riel, P.L., van-'t Hof, M.A., van Rijswijk, M.H., van Leeuwen, M.A., Kuper, H.H., van de Putte, L.B. Validity and reliability of joint indices. A longitudinal study in patients with recent onset rheumatoid arthritis. Br J Rheumatol 1993, 32, 589–594.

    PubMed  Google Scholar 

  6. Ritchie, D.M., Boyle, J.A., McInnes, J.M., et al. Clinical studies with an articular index for the assessment of joint tenderness in patients with rheumatoid arthritis. Quart J Med 1968, 37, 393–406.

    PubMed  Google Scholar 

  7. Thompson, P.W., Silman, A.J., Kirwan, J.R., Currey, H.L.F. Articular indices of joint inflammation in rheumatoid arthritis. Arthritis Rheum 1987, 30, 618–623.

    PubMed  Google Scholar 

  8. Felson, D.T., Andersen, J.J., Boers, M., et al. The American College of Rheumatology preliminary core set of disease activity measures for rheumatoid arthritis clinical trials. Arthritis Rheum 1993, 36, 729–740.

    PubMed  Google Scholar 

  9. Smolen, J.S., Breedveld, F.C., Eberl, G., Jones, I., Leeming, M., Wylie, G.L., Kirkpatrick, J. Validity and reliability of the twenty-eight-joint count for the assessment of rheumatoid arthritis activity. Arthritis Rheum 1995, 38, 38–43.

    PubMed  Google Scholar 

  10. van den Brink, H.R., van der Heide, A., Jacobs, J.W., van der Veen, M.J., Bijlsma, J.W. Evaluation of the Thompson articular index. J Rheumatol 1993, 20, 28–32.

    PubMed  Google Scholar 

  11. Hart, L.E., Tugwell, P., Buchanan, W.W., Norman, G.R., Grace, E.M., Southwell, D. Grading of tenderness as a source of interrater error in the Ritchie articular index. J Rheumatol 1985, 12, 716–717.

    PubMed  Google Scholar 

  12. Lewis, P.A., O'Sullivan, M.M., Rumfeld, W.R., Coles, E.C., Jessop, J.D. Significant changes in Ritchie scores. Br J Rheumatol 1988, 27, 32–36.

    Google Scholar 

  13. Thompson, P.W., Hart, L.E., Goldsmith, C.H., Spector, T.D., Bell, M.J., Ramsden, M.F. Comparison of four articular indices for use in clinical trials in rheumatoid arthritis: patient, order and observer variation. J Rheumatol 1991, 18, 661–665.

    PubMed  Google Scholar 

  14. Scott, D.L., Panayi, G.S., van Riel, P.L.C.M., van de Putte, L.B.A., Smolen, J. Disease activity in rheumatoid arthritis: preliminary report of the Consensus Study Group of the European Workshop for Rheumatology Research. Clin Exp Rheumatol 1992, 10, 521–525.

    PubMed  Google Scholar 

  15. Scott, D.L., Panayi, G.S., van Riel, P.L.C.M. Variations between centres when assessing disease activity. Clin Rheumatol 1993, 12, 37.

    Google Scholar 

  16. Egger, M.J., Huth, D.A., Ward, J.R., Reading, J.C., Williams, H.J. Reduced joint count indices in the evaluation of rheumatoid arthritis. Arthritis Rheum 1985, 28, 613–619.

    PubMed  Google Scholar 

  17. Bellamy, N., Carette, S., Ford, P.M., Kean, W.F., le Riche, N.G., Lussier, A., Wells, G.A., Campbell, J. Osteoarthritis antirheumatic drug trials. III. Setting the delta for clinical trials-results of a consensus development (Delphi) exercise. J Rheumatol 1992, 19, 451–457.

    PubMed  Google Scholar 

  18. Bellamy, N., Carette, S., Ford, P.M., Kean, W.F., le Riche, N.G. Lussier, A., Wells, G.A., Campbell, J. Osteoarthritis antirheumatic drug trials. II. Tables for calculating sample size for clinical trials. J Rheumatol 1992, 19, 444–450.

    PubMed  Google Scholar 

  19. Bellamy, N., Carette, S., Ford, P.M., Kean, W.F., le Riche, N.G., Lussier, A., Wells, G.A., Campbell, J. Osteoarthritis antirheumatic drug trials. I. Effects of standardization procedures on observer dependent outcome measures. J Rheumatol 1992, 19, 436443.

    Google Scholar 

  20. Bellamy, N., Anastassiades, T.P., Buchanan, W.F., Davis, P., Lee, P., McCain, G.A., Wells, G.A., Campbell, J. Rheumatoid arthritis antirheumatic drug trials. III. Setting the delta for clinical trials of antirheumatic drugs-results of a consensus development (Delphi) exercise. J Rheumatol 1991, 18, 1908–1915.

    PubMed  Google Scholar 

  21. Bellamy, N., Anastassiades, T.P., Buchanan, W.W., Davis, P., Lee, P., McCain, G.A., Wells, G.A., Campbell, J. Rheumatoid arthritis antirheumatic drug trials. I. Effects of standardization procedures on observer dependent outcome measures. J Rheumatol 1991, 18, 1893–1900.

    PubMed  Google Scholar 

  22. Klinkhoff, A.V., Bellamy, N., Bombardier, C., Carette, S., Chalmers, A., Esdaile, J.M., Goldsmith, C., Tugwell, P., Smythe, H.A., et al. An experiment in reducing interobserver variability of the examination for joint tenderness. J Rheumatol 1988, 15, 492494.

    Google Scholar 

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Scott, D.L., Choy, E.H.S., Greeves, A. et al. Standardising joint assessment in rheumatoid arthritis. Clin Rheumatol 15, 579–582 (1996). https://doi.org/10.1007/BF02238547

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