ObjectiveTo investigate the construct validity, reproducibility (ie, retest reliability) and internal responsiveness to treatment change of common single-item scales measuring overall pain in patients with rheumatoid arthritis (RA) and to investigate the corresponding effect of common pain-related comorbidities and medical consultation on these outcomes.Methods236 patients with RA completed a set of questionnaires including a visual analogue scale (VAS), a numerical rating scale (NRS) and a verbal rating scale (VRS) measuring overall pain before and immediately after routine medical consultation as well as 1 week after the patient's visit. Construct validity and retest reliability were evaluated using the Bravais-Pearson correlation while standardised response means (SRM) were calculated for evaluating internal responsiveness. Differences in the perception of pain were calculated using dependent samples t-tests.ResultsIn the total sample, construct validity was good across all three time points (convergent validity of pain scales: rT1–T3=0.82–0.92, p<0.001; discriminant validity as correlation of pain scales with age: rage=0.01–0.16, p>0.05). In patients maintaining antirheumatic treatment, retest reliability of pain scales was confirmed for all scales and across time points (rVAS=0.82–0.95, rNRS=0.89–0.98, rVRS=0.80–0.90, p<0.001), while the internal responsiveness of scales to a change in treatment was low across all scales (SRM=0.08–0.21). The VAS especially suggested a change in pain perception after medical consultation in patients maintaining therapy.ConclusionsThe VAS, NRS and VRS are valid and retest reliable in an outpatient clinical practice setting. The low pain scales’ internal responsiveness to treatment change is likely to be due to the short follow-up period. Patients with RA maintaining antirheumatic therapy seem to experience less pain after medical consultation.

Background Pain is the most limiting symptom of rheumatoid arthritis (RA) from the patients’ perspective [1]. Surprisingly, a psychometric comparison of common single-item scales measuring pain in RA (i.e. the visual analogue scale [VAS], the numerical rating scale [NRS], and the verbal rating scale [VRS]) remains to be performed. Objectives To investigate convergent validity, retest reliability and responsiveness of the VAS, the NRS, and the VRS in patients with RA. Moreover, to clarify whether these scales reflect differences in the perception of overall pain during and after medical consultation. Methods Patients were asked to complete the Health Assessment Questionnaire - Disability Index (HAQ-DI) plus additional items in disease activity and joint swelling or tenderness. The VAS, NRS, and VRS were distributed across this questionnaire to distract the patient’s attention from the previous rating on one of the pain scales. Patients were asked to complete this questionnaire three times: Before, immediately after and one week after the medical consultation. Additionally, information on age, sex, disease duration and disease activity at the time of questionnaire completion were recorded. We investigated convergent validity, retest-reliability, and sensitivity to change of the three pain scales and clarified whether patients reported different levels of overall pain rating among the three pain scales. Results 225 RA-patients (165 female) with a mean age of 57.09 ± 13.24 yrs and an average disease duration of 9.28 ± 8.95yrs agreed to take part in the survey. The average DAS28 at the time of medical consultation was 3.35 ± 1.56. The average HAQ-DI in the three questionnaires was found to be between 0.82 and 0.90 indicating some difficulties in doing daily physical activities during survey participation. Pearson correlation coefficients showed good convergent validity (r=0.83 to 0.91; all p < 0.001) and retest-reliability (r=0.79 to 0.97 for RA-patients maintaining anti-rheumatic treatment at consultation; all p < 0.001) of the pain scales at all time points [2]. In the subgroup of patients undergoing treatment adaptation, the standardized response mean (SRM) of all pain scales indicated low responsiveness (SRM=0.14 to 0.23) when using the one week follow-up. Interestingly, only the VAS reflected lower levels of pain immediately (t(201)=2.48;p=0.014) and one week after medical consultation (t(169)=2.38;p=0.019) when compared to the level of pain before seeing the physician. Conclusions Our study shows good convergent validity as well as retest reliability of the VAS, the NRS, and the VRS measuring overall pain in RA-patients but does not confirm previous results on the scales’ responsiveness. Although pain is a symptom that is varying in RA-patients from one day to another, only the VAS detected differences in the patients’ perception of pain. References Gossec L, Dougados M, Rincheval N, et al. Elaboration of the preliminary Rheumatoid Arthritis Impact of Disease (RAID) score: a EULAR initiative. Ann Rheum Dis...

Background Catheter-directed thrombolysis (CDT) is an effective and safe endovascular method used in critical limb ischemia and many other thromboembolic events. Ultrasound-assisted catheter-directed thrombolysis (US-CDT) is an emerging technique considered to accelerate thrombolysis and therefore is supposed to improve outcome. Purpose To evaluate the efficacy of US-CDT in comparison to standard CDT in vitro. Material and Methods A total of 69 sets of human venous blood were evaluated, each comprising a tube just treated with CDT, a tube treated with US-CDT, and a control tube. All tubes were kept under physiological conditions. Except for the controls, in all tubes 5 mg of tissue-type plasminogen activator was administered over the predetermined treatment interval. Thrombus mass was weighted at the end of the lysis intervals at 6 h or 24 h, respectively. Results CDT led to a mean thrombus reduction of 32% and ultrasound-assisted lysis led to a mean thrombus reduction of 41% ( P < 0.001 for both). Thrombus reduction was significantly higher after US-CDT compared to CDT ( P = 0.001). The better efficacy of US-CDT was mostly already apparent at early phases during thrombolysis and did further mildly increase over time (r = 0.24; P = 0.047). Conclusion In vitro US-CDT is significantly superior to standard CDT; this effect is apparent at an early timepoint of lysis and slightly further increases over time.