Background/Purpose: Management of patients with rheumatoid arthritis (RA) remains primarily according to a patient history and physical examination, unlike in many other chronic diseases, in which a “gold standard” biomarker, such as a laboratory test provides the primary basis for clinical management. A need for quantitative measures has led to a count of tender and swollen joints. A formal joint count is standard in clinical trials and clinical research, but not at most patient visits. Perhaps this phenomenon suggests that a joint examination without a formal quantitative joint count may be adequate, e.g., it matters considerably whether a patient has, say, 2 vs 12 swollen joints, but not necessarily whether the patient has 1 vs 2 or 11 vs 12 swollen joints. Furthermore, joint counts have relatively poor test-retest reliability, and can be affected by phenomena other than inflammatory activity, such as joint damage and/or distress. An alternative approach to quantitate a clinical encounter involves 3 physician visual analog scales (VAS) for inflammation, damage and distress to supplement a physician global assessment, as analyzed here.

Methods: At one private practice rheumatology site, all patients complete a patient self-report MDHAQ/RAPID3 at each visit. The rheumatologist performs a formal 28-joint count of tender (TJC) and swollen (SJC) joints, and then completes four 0-10 VAS, for overall global assessment, inflammation, damage, and distress. A random visit of 259 RA patients was studied for mean values, and correlations of the 4 physician VASs with SJC and TJC. Because correlations may be artefactually elevated if many patients have a value for a zero for the two variables compared, correlations also were calculated of patients whose SJC was >1.

Results: Mean values for the 0-10 VASs were 2.09 for physician global assessment, 2.50 for inflammation, 1.47 for damage and 0.74 for distress, as well as 4.17 for patient global assessment (Table). Mean SJC 28 was 5.15, and TJ C 28 2.54. SJC was correlated at significantly higher levels with the inflammation VAS, r=0.766 than the damage VAS, r=0.235, or distress VAS, r=0.030. In patients only with SJC >1, the correlation of SJC with the inflammation VAS was somewhat lower, r=0.688, but remained significantly higher than other correlations with physician VAS. The correlation of TJC was similar for overall global, inflammation and distress. The 4 VAS required about 15 seconds to complete vs about 90 seconds for a 28 joint count.

VAS=visual analog scale, SJC= swollen joint count, TJC= tender joint count

Conclusion: 3 physician VAS for inflammation, damage and distress may provide a useful tool to document a physician assessment of patient status and the rationale for clinical decisions, e.g., not escalating anti-inflammatory therapy in a patient with high RA index score who does not have high scores for inflammation but rather high scores for damage and/or distress.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/can-3-0-10-physician-visual-analog-scales-vas-to-assess-levels-of-inflammation-damage-and-distress-offer-comprehensive-quantitative-data-that-may-be-as-informative-as-detailed-formal-swollen-and-t/