Background/Purpose: In rheumatoid arthritis (RA) the target for treatment is clinical remission or minimal disease activity. Active involvement of patients in monitoring their own disease activity could enhance treatment by providing an early warning when targets are not met, indicating the need for a visit to evaluate treatment. The objective of this study is to determine if patients can self-monitor their RA disease activity and accurately identify whether they have reached the target of low disease activity or remission.

Methods: RA disease activity states from patient self-reported data and rheumatologist evaluation were compared. All consecutive RA patients presenting for follow-up to seven participating rheumatologists were invited to participate. Consenting patients filled out a questionnaire and performed a self-report joint count. Rheumatologist joint count and lab values (CRP) were obtained from rheumatologists’ charts.

RA disease activity indices (CDAI, SDAI and RAPID-4) were used to calculate disease activity, categorized into remission, low, moderate or high, according to published cut points. In patient versions of the CDAI and SDAI, physician global scores were replaced with the patient global score. Because change in treatment is recommended with moderate or high disease activity, we created two categories: remission or low vs. moderate or high. We also compared agreement across the four categories. Patient-derived and rheumatologist-derived activity states were compared using percent perfect agreement, as well as Cohen’s kappa for two category comparisons, and weighted kappa, which weighs how close the agreement is to perfect agreement, for four category comparisons.

Results: We recruited forty-nine RA patients [mean (SD) RA duration: 9.9(12.3) years; mean (SD) age: 57.7(15.4) years; 76% female]. Results suggest moderate to good agreement between patient and rheumatologist assessment of disease activity state when comparing patient-derived with rheumatologist-derived CDAI and SDAI, and when comparing RAPID-4 self-report assessment with rheumatologist CDAI and SDAI.

*values in 0.5-0.6 interval represent moderate agreement, all p < 0.001.

**values in 0.6-0.8 interval represent good agreement; all p < 0.001.

Conclusion: There is moderate to good agreement between patient self-assessment and rheumatologist assessment of disease activity, with little difference between instruments used. These results suggest that patients are able to assess their own disease activity, which may be helpful in guiding the need for physician visit and medication adjustments.