Measurement of stiffness in patients with rheumatoid arthritis in low disease activity or remission: a systematic review.
BACKGROUND
Recent qualitative research has shown that stiffness is an important symptom for patients to identify remission. However, it is unclear how to measure stiffness in low disease activity. This systematic review aims to summarise the existing literature on validity of patient reported outcomes to measure stiffness in RA low disease activity states, to aid the choice for a measurement instrument.


METHODS
An extensive pubmed-search was undertaken, identifying measurement instruments for patient perceived stiffness used in low disease activity. Eligible studies reported on 1) stiffness as an outcome in relation to other core set measures, 2) development of a patient reported tool to measure stiffness, or 3) comparison of two different tools to measure aspects of stiffness, all in low disease activity.


RESULTS
Of 788 titles, only two studies report on validity of stiffness measures within low disease activity. Morning stiffness (MS) is reported in 44 to 80% of patients in low disease activity. A difference of 40 to 60 minutes in duration until maximum improvement is observed between active and inactive patients. Severity of MS might discriminate better between high and low disease activity compared to measurement of duration of MS.


CONCLUSIONS
There is insufficient data on measurement of stiffness in the spectrum of low disease activity or remission.
Department of Rheumatology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands. L.vantuyl@vumc.nl.
Lilian H D
LH
van Tuyl
Willem F
WF
Lems
Maarten
M
Boers
D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D001696:Biomechanical Phenomena; D002940:Circadian Rhythm; D006801:Humans; D007596:Joints / Q000503:physiopathology*; D063868:Patient Outcome Assessment; D011237:Predictive Value of Tests; D012074:Remission Induction; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome