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THU0210 Clinical longterm updateable evaluation (clue) forms for clinical features and medications used in the management of patients with rheumatoid arthritis
  1. T Sokka,
  2. T Pincus
  1. Division of Rheumatology, Vanderbilt University, Nashville, USA

Abstract

Background Rheumatologists collect similar data in the care of patients with rheumatoid arthritis (RA) concerning clinical features, such as extra-articular disease, comorbidities, and classification criteria, as well as a history of therapies used in patient management. However, these data generally are collected in non-standard formats. Therefore, much clinical data are not easily accessible to the clinician in routine long-term care of individual patients, or to workers in clinical research concerning cohorts of patients at one centre or multiple centres. Advances in laboratory and clinical science are enhanced when data are collected in a standard format.

Objectives To develop two clinical long term updateable evaluation (CLUE) standard forms for use in the management of patients with RA, one concerning clinical features, and the second concerning medication history, which can be maintained indefinitely at the front of the medical record.

Methods Two one page CLUE forms were developed for use in usual clinical care. The RA clinical features CLUE form includes extra-articular disease, comorbidities, classification criteria for RA, possible family history of RA, records of joint surgeries/dates and radiographs. The medication review CLUE form includes all DMARDs and most current NSAIDs. Each form is designed to be updated easily at each visit, without a need to collect the data again.

Results The CLUE forms have been used to characterise 102 consecutive patients with RA in routine clinical care. Medications in current use included prednisone (median dose 4 mg per day) by 94% of patients, methotrexate (median dose 15 mg per week) by 86%, hydroxycholoroquine by 28%, leflunomide by 10%, cyclosporine by 8%, etanercept by 8%, infliximab by 8%, auranofin by 3%, gold injections by 3%, azathioprine by 2%, penicillamine by 1%, and sulfasalazine by 1% of patients. Extra-articular disease included malaise reported by 72% of patients, dry mouth by 46%, carpal tunnel syndrome 37% dry eyes by 35%, and scleritis by 9% of patients at any time in the course of RA. Comorbities included chronic back pain in 36% of patients, hypertension in 31%, peptic ulcer in 27%, esophageal symptoms in 25%, cataract in 20%, thyroid disease in 11%, cancer in 10%, diabetes mellitus in 4%, renal disease in 3% of patients. Sixty-three percent of patients had smoked cigarettes and 28% were current smokers.

Conclusion Two simple clinical longterm updateable evaluation (CLUE) forms are easily completed in usual clinical care to characterise patients with RA. These forms are complemented by a patient questionnaire and joint count form, to provide simple, standardised measures of RA for improved clinical care, clinical research, and clinical outcomes.

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