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Joint counts variability in rheumatoid arthritis patients followed in a real-life setting

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Resumo:In rheumatoid arthritis (RA), the tender and swollen joint counts play a key role in the clinical assessment of disease activity, integrating the disease activity score (DAS), which is determinant in the treatment decision. However, there is considerable variability in these measurements. In this project, we aimed to identify the variables influencing the joint counts, and to determine if there was a significant difference in these measurements when performed in clinical practice by Rheumatology registrars and consultants. For that purpose, we analyzed the possible effect of several variables on the joint counts, by analyzing consecutive visits (n=3127) of 260 patients followed in a real life setting. We compared the differences in the assessment of disease activity parameters between the registrars and consultants using the Student’s T-test. To study the impact of each variable in the tender and swollen joint counts, we conducted a multivariate analysis using a linear mixed model. Overall, registrars and consultants counted a similar mean number of tender but a higher number of swollen joints (1.6±2.8 vs. 2.0±3.7; P-value=0.001). However, when adjusting for other variables, neither the training status, nor the years of experience were associated with the joint counts. Importantly, variables such as the patient global visual analogue scale (VAS), physician VAS and disease duration had a significant impact on both the tender and swollen joint counts. Furthermore, the patient’s age was significantly associated with the tender joint count. We also found that the inter-observer and inter-patient variabilities were both significant, which can be further investigated in studies that consider simultaneous assessment of patients by several evaluators. We conclude that neither the physician training status nor the years of experience have impact in the joint counts, but the disease activity parameters do.
Autores principais:Kakoo, Nuno Filipe de Gouveia
Assunto:Artrite reumatóide Contagens articulares Treino em reumatologia Reumatologia
Ano:2017
País:Portugal
Tipo de documento:dissertação de mestrado
Tipo de acesso:acesso aberto
Instituição associada:Universidade de Lisboa
Idioma:inglês
Origem:Repositório da Universidade de Lisboa

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