Systematic Review and Metaanalysis of Patient Self-Report versus Trained Assessor Joint Counts in Rheumatoid Arthritis

Abstract

Objective Patient self-report outcomes and physician-performed joint counts are important measures of disease activity and treatment response. This metaanalysis examines the degree of concordance in joint counts between trained assessors and patients with rheumatoid arthritis (RA). Methods Studies eligible for inclusion met the following criteria: English language; compared patient with trained assessor joint counts; peer-reviewed; and RA diagnosis determined by board-certified or board-eligible specialist or met 1987 American College of Rheumatology criteria. We searched PubMed and Embase to identify articles between 1966 and January 1, 2008. We compared measures of correlation between patients and assessors for either tender/painful or swollen joint counts. We used metaanalysis methods to calculate summary correlation estimates. Results We retrieved 462 articles and 18 were included. Self-report joint counts were obtained by a text and/or mannequin (picture) format. The summary estimates for the Pearson correlation coefficients for tender joint counts were 0.61 (0.47 lower, 0.75 upper) and for swollen joint counts 0.44 (0.15, 0.73). Summary results for the Spearman correlation coefficients were 0.60 (0.30, 0.90) for tender joint counts and 0.54 (0.35, 0.73) for swollen joint counts. Conclusion A self-report tender joint count has moderate to marked correlation with those performed by a trained assessor. In contrast, swollen joint counts demonstrate lower levels of correlation. Future research should explore whether integrating self-report tender joint counts into routine care can improve efficiency and quality of care, while directly involving patients in assessment of RA disease activity.

Differences in activity limitation, pain intensity, and global health in patients with rheumatoid arthritis in Sweden and the USA: a 5-year follow-up

“…This may also be a problem in other variables. According to Barton et al (20), joint count performed by a trained assessor, as in the TIRA cohort, and self-reported swollen joints, as in the UCSF cohort, show a low level of correlation. Furthermore, in the TIRA cohort, the slightly modified Swedish version of the HAQ was used.…”

Swedish version of the multi dimensional health assessment questionnaire – translation and psychometric evaluation

“…The included RAPID3 and the RADAI have high reliability [16]. The RADAI is a valid instrument [17,18], and patient reported tender joint count has a moderate to marked correlation to assessment by health professionals [19]. …”

Comprehensive Arthritis Referral Study — Phase 2: Analysis of the Comprehensive Arthritis Referral Tool

“…A systematic review and metaanalysis of patient-reported joint counts found self-reported tender joint counts to have moderate to marked correlation with those performed by a trained assessor 27 . In contrast, swollen joint counts demonstrated lower levels of correlation.…”