title: Patient self-assessment and physician's assessment of rheumatoid arthritis activity: which is more realistic in remission status? A comparison with ultrasonography.
abstract: OBJECTIVE
  The objective of this study was to compare disease activity assessed by the patient, the physician and musculoskeletal US in patients with RA in clinical remission.
  
  
  METHODS
  We evaluated 69 patients with RA in clinical remission according to their attending rheumatologist. Tenderness and swelling in 28 joints were blindly assessed by patients and physicians. The presence of B-mode and Doppler synovitis was blindly investigated in the above joints. The DAS28 and Simplified Disease Activity Index (SDAI) were calculated.
  
  
  RESULTS
  The percentage of patients in remission according to the self-derived DAS28 (26.1%) was significantly less than that according to the physician-derived DAS28 (52.2%) (P < 0.0005). There was no significant difference in the percentage of patients in remission according to the self-derived SDAI (14.5%) and the physician-derived SDAI (11.6%) (P = 0.172). We found moderate agreement between the patient-derived and physician-derived DAS28 and SDAI [intraclass correlation coefficient (ICC) = 0.620 and ICC = 0.678, respectively]. Agreement between patient and physician was better for the tender joint count (TJC; ICC = 0.509) than for the swollen joint count (SJC; ICC = 0.279). The mean (S.D.) count for B-mode synovitis [4.09 (3.25)] was significantly greater than the SJC assessed by both the patient and physician [2 (3.71) and 1.42 (2.03), respectively] (P < 0.0005 and P = 0.033, respectively). We found moderate agreement between the physician-assessed SJC and the joint count for Doppler synovitis (ICC = 0.528).
  
  
  CONCLUSIONS
  Patient-assessed and physician-assessed overall RA activity showed acceptable agreement. Patient self-assessment overestimated disease activity determined by the DAS28. At the patient level, physician-assessed joint swelling showed an acceptable concordance with Doppler US synovitis.
authors.affiliation: Str. Trivale, Nr. 44, Pitesti, 110058 Arges, Romania. iustinajanta@yahoo.com.
authors.forename: Iustina
authors.initials: I
authors.lastname: Janta
authors.forename: Esperanza
authors.initials: E
authors.lastname: Naredo
authors.forename: Lina
authors.initials: L
authors.lastname: Martínez-Estupiñán
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Nieto
authors.forename: Inmaculada
authors.initials: I
authors.lastname: De la Torre
authors.forename: Lara
authors.initials: L
authors.lastname: Valor
authors.forename: Lidia
authors.initials: L
authors.lastname: Estopiñán
authors.forename: Natalia
authors.initials: N
authors.lastname: Bello
authors.forename: Michelle
authors.initials: M
authors.lastname: Hinojosa
authors.forename: Carlos Manuel
authors.initials: CM
authors.lastname: González
authors.forename: Javier
authors.initials: J
authors.lastname: López-Longo
authors.forename: Indalecio
authors.initials: I
authors.lastname: Monteagudo
authors.forename: María
authors.initials: M
authors.lastname: Montoro
authors.forename: Luis
authors.initials: L
authors.lastname: Carreño
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy; D003430:Cross-Sectional Studies; D059026:Diagnostic Self Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010808:Physical Examination; D011446:Prospective Studies; D012074:Remission Induction; D012720:Severity of Illness Index; D013585:Synovitis / Q000175:diagnosis / Q000000981:diagnostic imaging; D014463:Ultrasonography
chemical_list: D018501:Antirheumatic Agents
keywords: patient assessment; physician assessment; remission; rheumatoid arthritis; ultrasound