Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


A Checklist of 10 Measures, 6 from a Patient Questionnaire & 4 Physician Global Scores, Requiring <15 Seconds, To Provide Quantitative Patient History & Physical Examination Data, Analogous to Laboratory Tests, for Usual Clinical Care.

Pincus4,  Theodore, Yazici2,  Yusuf, Bergman1,  Martin J., Sokka3,  Tuulikki, Swearingen5,  Christopher J.

Arthritis and Rheumatology, Ridley Park, PA
Hospital for Joint Diseases, Hastings on Hudson, NY
Jyvaskyla Central Hospital, Jyvaskyla, Finland
New York University Hospital for Joint Disease, Hastings-on-Hudson, NY
University of Arkansas for Medical Sciences, Little Rock, AR

Purpose:

To analyze a proposed checklist of 10 quantitative measures, 6 from a patient questionnaire and 4 physician global scores, compiled in less than 20 seconds, to provide quantitative patient history and physical examination (PE) data, which rheumatologists indicate are more important than laboratory tests in clinical decisions in usual care visits.

Methods:

The 6 quantitative patient measures are from a self-report multidimensional health assessment questionnaire (MDHAQ) for: physical function (FN) (0–10); 21 circle 0–10 visual analog scales for pain (PN), patient global estimate (PTGL), and fatigue (FT); review of 60-symptom checklist (SX); and RAPID3, a 0–30 total of FN+PN+PTGL whcih requires 5 seconds. The 6 scores are compared on a flow sheet to scores at previous visits prior to the traditional patient encounter. The rheumatologist records 4 global estimates for: overall status (0–10), and 3 0–3 global scales for levels of inflammatory activity, joint or other organ damage, and non-inflammatory/fibromyalgia symptoms, recoded 0–10 to compare to other measures. An updated flow sheet report includes the 10 proposed checklist scores, as well as laboratory tests and medications. Mean 1st visit values for the 10 proposed checklist measures were analyzed in all 874 new patients seen at a weekly academic setting from 1996–2007 in 8 groups: rheumatoid arthritis (RA), osteoarthritis (OA), fibromyalgia (FM), systemic lupus erythematosus (SLE), gout, spondyloarthropathy (Spondy), inflammatory polyarthritis (InflPol), connective tissue disease (CTD), and "other," as well as demographic data, ESR and CRP, compared using Spearman rank order correlations.

Results:

The 874 patients appear typical for rheumatic diseases (Table). ESR was >20 mm/Hr in RA, OA, SLE, Spondy, and CTD, while CRP was >10 mg/dL in RA and Spondy. Mean MDHAQ FN was highest in RA and also >3.0 in FM and Spondy. Mean PAIN was highest in FM, and >5 in Spondy, RA and InflPol; PTGL >5 in FM, RA and Spondy; FT >5 in FM, RA, SLE, InflPol, and other. Symptom scores were >20 only in FM. Mean MD global estimates were >=5.0 in all 8 categories - mean 5.7. Estimates were >5 for inflammation in Spondy, RA, gout, InflPol, and CTD; for damage only in RA and OA; and for noninflam/fibro symptoms in FM, SLE, and other.

Quantitative demographic, laboratory tests, patient MDHAQ scores, and MD global estimates in 874 new rheumatology patients, by diagnosis, Spondy = Spondylarthropathies. InflPol = Inflammatory Polyarthritis.

 RAOAFMSLEGoutSpondyInflPolCTDOtherTotal
Number of patients1743219634123015250194874
Demographic and laboratory measures
Age (years)54.565.147.038.859.343.951.947.651.050.7
Disease duration (years)8.46.35.99.19.111.34.86.95.46.6
Formal education (years)13.015.013.713.613.814.914.213.913.913.8
% Female71.3%65.6%88.7%85.3%16.7%46.7%72.9%82.0%71.7%74.9%
ESR (mm/h)29.722.216.828.911.126.516.622.118.621.6
CRP (mg/dL) [normal < 10]17.53.96.16.73.611.56.17.98.69.9
Patient MDHAQ self-report questionnaire measures for proposed checklist
1. Function (FN) [0–10]3.22.33.01.91.83.02.22.12.42.7
2. Pain (PN) [0–10]5.44.46.53.75.85.95.03.05.25.3
3. Global (PTGL) [0–10]5.44.46.14.33.85.14.53.94.85.1
4. RAPID3 [0–30]13.710.015.48.510.213.411.48.311.012.4
5. Fatigue (FT) [0–10]5.74.27.35.44.14.55.34.85.05.7
6. Symptoms (SX) [0–60]14.19.420.516.17.711.413.813.212.814.9
MD global measures fir proposed checklist
7. MD Global [0–10]6.36.36.35.05.06.35.35.35.65.7
8. Inflammation [0–10]7.03.32.33.66.07.75.75.33.74.7
9. Damage [0–10]5.06.01.72.33.04.33.03.33.03.3
10. Non-inflam/fibro [0–10]4.03.79.06.32.34.04.03.35.05.3
Shaded: Lab: ESR>20. CRP>10. Pt measures: FN>3, PN>=5, PTGL>=5, FT>=5, RAPID3>12, SX>20. All MD measures >=5.

Conclusion:

A proposed checklist of 10 measures, 6 from a MDHAQ and 4 global MD scores, provides quantitative data from a history and PE at each encounter in the infrastructure of rheumatology care, in <20 seconds. These data provide quantitative measures to assess patient status over long periods, "treat to target" values, and may lead to improved patient outcomes.

To cite this abstract, please use the following information:
Pincus, Theodore, Yazici, Yusuf, Bergman, Martin J., Sokka, Tuulikki, Swearingen, Christopher J.; A Checklist of 10 Measures, 6 from a Patient Questionnaire & 4 Physician Global Scores, Requiring <15 Seconds, To Provide Quantitative Patient History & Physical Examination Data, Analogous to Laboratory Tests, for Usual Clinical Care. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :985
DOI: 10.1002/art.28752

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