The reliability of self-assessment joint counts as an indicator of disease severity in patients with rheumatoid arthritis

Purpose Rheumatoid arthritis is a condition with multiple exacerbations and remissions. During a flare patients often need to be seen by rheumatology services for appropriate management. At our hospital patients are not routinely followed up but via patient initiated consultation. At first telephone contact it would be useful to have an objective indication of the disease severity in order to prioritise patients appropriately. A further application would be for the regular monitoring of disease response in our large number of patients on anti-TNF therapy. Previous work on self assessment joint counts has suggested that they would not be suitable to replace assessor counts.1 We assessed the reliability of such counts as an indicator of disease severity and application to facilitate patient initiated consultations. Methods 22 patients with stable chronic rheumatoid arthritis were trained to carry out self assessment joint counts for both swollen and tender joints. Mean age was 52 years. 10 patients were trained on one occasion only and 12 patients were trained over 5 appointments. One patient was excluded because severely reduced dexterity made accurate self-assessment impossible. 21 patients were included for analysis. Using patient counts, plus a VAS score and most recent ESR we were able to generate a patient DAS-28. A clinician DAS-28 was also carried out. Results We found patients enthusiastic about taking part. There was a strong correlation between patient completed DAS-28 and clinician DAS-28 (r=0.898, p