title: Reliability of joint count assessment in rheumatoid arthritis: a systematic literature review.
abstract: BACKGROUND
  Joint counts are central to the assessment of rheumatoid arthritis (RA) but reliability is an issue.
  
  
  OBJECTIVE
  To evaluate the reliability and agreement of joint counts (intra-observer and inter-observer) by health care professionals (physicians, nurses, and metrologists) and patients in RA, and the impact of training and standardization on joint count reliability through a systematic literature review.
  
  
  METHODS
  Articles reporting joint count reliability or agreement in RA in PubMed, EMBase, and the Cochrane library between 1960 and 2012 were selected. Data were extracted regarding tender joint counts (TJCs) and swollen joint counts (SJCs) derived by physicians, metrologists, or patients for intra-observer and inter-observer reliability. In addition, methods and effects of training or standardization were extracted. Statistics expressing reliability such as intraclass correlation coefficients (ICCs) were extracted. Data analysis was primarily descriptive due to high heterogeneity.
  
  
  RESULTS
  Twenty-eight studies on health care professionals (HCP) and 20 studies on patients were included. Intra-observer reliability for TJCs and SJCs was good for HCPs and patients (range of ICC: 0.49-0.98). Inter-observer reliability between HCPs for TJCs was higher than for SJCs (range of ICC: 0.64-0.88 vs. 0.29-0.98). Patient inter-observer reliability with HCPs as comparators was better for TJCs (range of ICC: 0.31-0.91) compared to SJCs (0.16-0.64). Nine studies (7 with HCPs and 2 with patients) evaluated consensus or training, with improvement in reliability of TJCs but conflicting evidence for SJCs.
  
  
  CONCLUSIONS
  Intra- and inter-observer reliability was high for TJCs for HCPs and patients: among all groups, reliability was better for TJCs than SJCs. Inter-observer reliability of SJCs was poorer for patients than HCPs. Data were inconclusive regarding the potential for training to improve SJC reliability. Overall, the results support further evaluation for patient-reported joint counts as an outcome measure.
authors: Division of Rheumatology, National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Rheumatology, University of Sydney, Institute of Bone and Joint Research, Royal North Shore Hospital, St Leonards, Australia. Electronic address: peter_cheung@nuhs.edu.sg.
authors: Peter P
authors: PP
authors: Cheung
authors: Department of Rheumatology, UPMC Univ Paris 06, GRC-UPMC 08 (EEMOIS), AP-HP, Pitié-Salpêtrière Hospital, Paris, France.
authors: Laure
authors: L
authors: Gossec
authors: Division of Rheumatology, National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors: Anselm
authors: A
authors: Mak
authors: Department of Rheumatology, University of Sydney, Institute of Bone and Joint Research, Royal North Shore Hospital, St Leonards, Australia.
authors: Lyn
authors: L
authors: March
mesh_terms: D001172:Arthritis, Rheumatoid / Q000175:diagnosis*; D006801:Humans; D007596:Joints; D015588:Observer Variation; D015203:Reproducibility of Results; D057566:Self Report; D012720:Severity of Illness Index
keywords: Clinical examination; Health care professional and patient joint counts; Reliability; Reproducibility; Rheumatoid arthritis; Synovitis