Background Early recognition of rheumatoid arthritis (RA) is very important. Earlier treatment leads to a better outcome in RA patients, the so called window of opportunity. Previous research into the ability of patients to recognize arthritis has been done in diagnosed RA and ankylosing spondylitis patients. The present study is the first to investigate the reliability of self-evaluation of the swollen joint count (SJC) in patients presenting with arthralgia.
Objectives The aim of this study was to evaluate whether patients referred with arthralgia are capable of recognizing arthritis themselves.
Methods In total, 643 patients referred to the Early Arthritis Recognition Clinics of Groningen and Leiden (both the Netherlands) between April 2012 and December 2013 were studied. General practitioners (GP) referred patients with arthralgia to this clinic if they had a suspicion of arthritis, but were unsure about the presence of arthritis. Patients filled in a questionnaire about their joint symptoms, including a SJC (range 0-52) on a mannequin. Subsequently they were evaluated by an experienced rheumatologist for the presence of arthritis. Correlations between patient and physician SJC were calculated using Spearman's correlation coefficient (rho). Agreement between patient and physician scores was calculated using Cohen's Kappa (K) or intraclass correlation coefficient (ICC).
Results The median number of swollen joints scored by patients and physicians was 2 (0-46) and 0 (0-25) respectively. The correlation between patient and physician total SJC was low (rho 0.240). Furthermore, there was no agreement between patients and physicians for the presence of any arthritis (SJC ≥1, K 0.174) or total SJC (ICC 0.146). Also when looking at individual joints, agreement between patients and physicians was low. Arthritis was not more easily identified by patients in large vs small joint involvement (K 0.240 and 0.119 resp.), in symmetrical hand joint affliction (K 0.283), or for the number of afflicted joints (mono vs oligo vs polyarticular, K 0.158). No differences were found between men and women (K 0.235 and 0.160 resp.) and between age groups (ages <30, 30-59, ≥60 years, K 0.460, 0.181, 0.200 resp.).
Conclusions This is the first study evaluating the ability of (selected) patients from the general population to recognize arthritis. Our results show that these patients are not capable of recognizing arthritis as diagnosed by an experienced rheumatologist. Based on these data we conclude that self assessed arthritis is not an appropriate tool to screen arthralgia patients for the presence of arthritis.
Spoorenberg A, van der Heijde D, Dougados M et al. The reliability of self assessed joint counts in ankylosing spondylitis. Ann Rheum Dis 2002;61:799-803.
Riazolli J, Nilsson JÅ, Teleman A et al. Patient-reported 28 swollen and tender joint counts accurately represent RA disease activity and can be used to assess therapy responses at the group level. Rheumatology 2010;49:2098-2103.
Disclosure of Interest None declared