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OP0053 A Randomized Controlled TRIAL of Improving Patient Self-Assessment of Synovitis in Rheumatoid Arthritis with Education by Ultrasonography: the Raeus Study
  1. P. Cheung1,
  2. M. Lahiri1,
  3. G.G. Teng1,
  4. A. Lim1,
  5. T.C. Lau1,
  6. A. Lateef1,
  7. A. Mak1,
  8. L. Gossec2,
  9. L. March3
  1. 1Rheumatology, National University Hospital, Singapore, Singapore, Singapore
  2. 2Rheumatology, UPMC Univ Paris 06 and Pitié Salpêtrière Hospital, Paris, France
  3. 3Rheumatology, Royal North Shore Hospital, Sydney, Australia

Abstract

Background Patients can potentially monitor disease activity in rheumatoid arthritis (RA) by performing self-assessment of joint counts. However, reliability of self-assessed swollen joint count is generally poor [1].

Objectives To evaluate the use of education by using feedback from ultrasound (US) images on the ability of patients to assess swollen joints in RA.

Methods Study design: 6-month single centre unblinded randomized controlled trial, stratified by age and disease activity. Patients: Consecutive patients with established RA. Intervention: (i) education on self-assessment of joints: initial brief patient training on tender (TJC) and swollen (SJC) joint counts, followed by US feedback for areas of active synovitis every 3 months (EUS) versus (ii) standard care (no education on self-assessment and feedback with US). Patient and physician independently performed 28-joint counts at each study visit, with US feedback for areas of active synovitis provided for patients in the intervention arm only, at end of each visit. Outcome variables: Primary: Agreement at “joint” level - Proportion of patients with good agreement with physician derived swollen joints (i.e. prevalence-adjusted bias adjusted kappa, PABAK more than 0.6). Secondary: Agreement at “patient” level: i.e. SJC between patients and physician using Bland and Altman 95% limits of agreement, disease activity indices between the 2 groups, proportion of patients achieving remission, feasibility and patient satisfaction survey according to a 5-point Likert scale on the joint count training method by US.

Results Ninety-two out of 101 patients completed the study (n=48 EUS, n=44 standard care). There were no differences in baseline characteristics. Mean age was 54.5±12.8 yrs, disease duration 6.3±6.0 yrs, with mean Disease Activity Score (DAS28) 3.3±1.1 (26% in DAS28 remission). At 6 months, the proportion of patients with swollen joint PABAK>0.6 was greater in the EUS arm compared to standard care (98% vs. 82%, p=0.009). The Bland and Altman limits of agreement for SJC difference between physician and patients were reduced only in the EUS arm. At 6 months, there were no significant inter-group differences in disease activity although a trend to higher DAS28 remission in the EUS arm (46% vs. 28% in standard care, p=0.08). Training with US was considered feasible (15-20 minutes) with 94% of patients reporting it as useful for appreciating their own disease activity.

Conclusions A short course of patient education with US feedback can improve patient-physician reliability for the assessment of swollen joints. Larger studies with longer follow up are required to evaluate the clinical benefits.

References

  1. Cheung et al. Sem Arthritis Rheum 2013 (nov 13) [Epub ahead of print]

Disclosure of Interest None declared

DOI 10.1136/annrheumdis-2014-eular.2203

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