Background/Purpose: A physician estimate of a patient’s global status (DOCGL) often is most often the most efficient of all 7 rheumatoid arthritis (RA) core data set measures to distinguish active from control treatments in clinical trials(1). DOCGL is designated to assess inflammatory activity. However, DOCGL may be influenced by damage, as seen in comorbid osteoarthritis (OA), and distress, as seen in fibromyalgia and chronic pain syndromes. Indeed, it may be suggested that the expertise of a rheumatologist is directed to a form of “triage” in chronic diseases, to recognize the extent to which a patient’s signs and symptoms may be explained by inflammation, damage, and/or distress. Therefore, 3 new physician 0-10 visual analog scales (VAS) developed to estimate subsets of DOCGL. We analyzed physician scales for overall global status, inflammation, damage and distress in patients with RA, osteoarthritis (OA), and fibromyalgia (FM).

Methods: Patients seen in routine care at one academic clinical setting are assigned 4 0-10 VAS estimates for overall DOCGL, inflammation or reversible problems, damage (to any organ) or irreversible problems, and/or distress, as seen in fibromyalgia, depression, chronic pain syndrome, etc. A cross-sectional analysis was performed of a random visit between September and December 2014 of consecutive patients with 3 primary diagnoses: RA (n=108), OA (n=131), and FM (n=51). The medians and interquartile ranges (IQR) of non-normally distributed data and Spearman correlations were computed to estimate associations of the overall DOCGL with subscales and PATGL in the 3 diagnosis groups.

Results: Median DOCGL ranged from 3 to 5, highest for patients with FM (5.0), followed by OA (4), and RA (3.5). The highest median score for inflammation was for patients with RA (1.5), for damage in patients with OA (4.2) and for distress in patients with FM (5.2) (Table). The highest correlation with DOCGL was seen for the inflammation scale in RA, damage in OA, and distress in FM. DOCGL was correlated significantly with PATGL in RA and OA, but not in FM.

Conclusion: Physician estimates for inflammation, damage, and distress differ according to different rheumatic diagnoses. These 3 subscales supplement the overall physician global estimate as a quantitative summary of the history and physical examination, to estimate levels of inflammation, damage, and distress in an individual patient, analogous to triage function in acute injury, to support clinical decisions in patients with chronic rheumatic diseases in usual care.

Reference: 1)Pincus T, et al. Clin Exp Rheumatol. 2014;32 Suppl 85(5):47-54.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/triage-in-chronic-rheumatic-diseases-quantitative-physician-estimates-for-inflammation-reversible-damage-irreversible-and-distress-in-patients-with-rheumatoid-arthritis-osteoarthritis-and-fib/