Validation of patient-reported joint counts in rheumatoid arthritis and the role of training.
OBJECTIVE
To demonstrate the effectiveness of simple training on improving the ability of patients with rheumatoid arthritis (RA) to assess joint swelling, and to validate the use of a computerized questionnaire, the Health Assessment Questionnaire (HAQ-ulous), to collect patient-reported tender and swollen joint counts.


METHODS
Sixty patients completed the HAQ-ulous, reporting pain and swelling of the 28 joints included in the Disease Activity Score-28. A rheumatologist blinded to the patients' responses assessed each joint for the presence of tenderness and swelling. At followup visits, 30 patients received training in distinguishing a swollen joint from a chronically enlarged joint, completed the HAQ-ulous again, and were reassessed by the physician.


RESULTS
At the initial visit, a strong correlation was shown between patient- and clinician-reported tender joints [Pearson correlation coefficient (r(p)) = 0.79; p < 0.0001]. Correlation between patient- and clinician-reported swollen joints was less robust (r(p) = 0.41; p = 0.001). Following training at the second visit, agreement between patients and the clinician improved for both tender joints (r(p) = 0.94; p < 0.0001) and swollen joints (r(p) = 0.93; p < 0.0001).


CONCLUSIONS
With simple training in distinguishing swollen joints from chronically enlarged joints, the majority of patients are able to accurately assess joint swelling. Objective tools, such as the HAQ-ulous, that incorporate patient-reported outcomes are a valuable and reliable addition to standard clinical practice for monitoring patients with RA.
Levy
Gerald
G
Department of Rheumatology, Southern California Kaiser Permanente, Bellflower, California 90242, USA. gerald.d.levy@kp.org
Cheetham
Craig
C
Cheatwood
Allison
A
Burchette
Raoul
R
D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000473:pathology*; D003194:Computer-Assisted Instruction; D005260:Female; D006306:Health Surveys; D006801:Humans; D007596:Joints / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D010817:Physician-Patient Relations; D015203:Reproducibility of Results; D012219:Rheumatology / Q000193:education; D016353:Self-Examination; D012720:Severity of Illness Index