Patient self-report tender and swollen joint counts in early rheumatoid arthritis

Objective. To determine the correlation between patient self-report joint c ounts and standard physician joint counts, and to compare pictorial (Manneq uin) and text (Rapid Assessment of Disease Activity in Rheumatology, RADAR) formats for obtaining patient self-reports, Methods. Baseline patient self-report joint counts were mailed and complete d by 60 patients with early rheumatoid arthritis (RA) one day before and on e day after being examined by a physician. Twenty-seven were randomized to the Mannequin tender and Mannequin swollen joint counts; 33 were randomized to the RADAR tender and swollen joint counts. Agreement between patient an d physician self-report joint counts, diagnostic characteristics, and lest- retest reliability of patient self-report joint counts was computed. Stepwi se regression analyses were performed to identify predictors of patient-phy sician differences in total joint count. Results, Means and standard deviations of paired patient and physician tota l joint counts were not different for Mannequin or RADAR forms. Spearman co rrelations were moderate (0.58 to 0.69 for Mannequin, 0.37 to 0.58 for RADA R). Agreement (intraclass correlations) was 0.65 for the Mannequin and 0.56 for the RADAR forms. Patient test-retest reproducibility was moderate for RADAR tenderness (0.58) and high (r > 0.90) for RADAR swollen and both Mann equin forms, Level of patient education predicted patient-physician differe nces on the RADAR swollen joint counts (p = 0,003), but was not significant in Mannequin forms, suggesting that education was not a factor in accurate completion of Mannequin forms, Conclusion, Both pictorial and text format patient self-report joint counts are significantly correlated with physician joint counts, In addition to m oderately high patient test-retest reproducibility, this suggests that pati ent self-reports in both formats may yield accurate measures of improvement in disease activity.