Background/Purpose:

Quantitative measures such as laboratory tests and pooled indices have advanced clinical rheumatology care far beyond narrative decisions. These measures generally are directed to assess inflammatory activity, based on the primary concern of rheumatologists to control inflammation in order to prevent damage to joints and other organs. However, structural damage and patient distress, seen as fibromyalgia, depression, etc., are important clinical problems in many patients, in addition to active inflammation, but are not assessed quantitatively in routine clinical care, or even much clinical research concerning inflammatory rheumatic diseases. We introduced quantitative assessment of inflammation, damage, and distress in care of individual rheumatology patients, and hypothesized that structural damage and distress would be at least as important in current practice as inflammation. Here, we assess the relative contribution of each to physician global assessment.

Methods:

As part of routine care, rheumatologists at one academic site complete a 0-10 physician global assessment (DOCGL) VAS, as well as 3 further 0-10 VAS to assess inflammation ­(reversible disease) (DOCINF), joint and other organ damage (irreversible disease) (DOCDAM), and patient distress (fibromyalgia, depression), etc. (DOCSTR). The proportion of DOCGL attributed to inflammation, damage, and distress (total=100%) also is estimated. Mean values were analyzed in a cross-sectional study of 570 patients, and compared in subgroups of 98 with rheumatoid arthritis (RA), 131 with osteoarthritis (OA) and 89 with fibromyalgia (FM), using t tests and analysis of variance (ANOVA).

Results:

Mean 0-10 DOCGL scores were 4.4 in all patients, 4.4 in OA, 4.6 in RA, and 5.2 in FM (Table) (p=0.04). Highest mean scores were seen for DOCINF in RA, DOCDAM in OA, and DOCSTR in FM, and differing significantly in each diagnosis (Table), confirming face validity. Importantly, damage VAS scores (DOCDAM) were higher than inflammation (DOCINF) scores in all groups, including in RA, and mean estimates of the proportion of DOCGL attributed primarily to damage were greater than to inflammation in all conditions (Table). Scores for DOCSTR were higher than for DOCINF in all patients and subgroups, other than in RA.

Conclusion:

Physician VAS scores and DOCGL sub-scores attributed to damage and distress in individual patients were higher than for inflammation in all diagnosis groups, even in RA patients as a group. Control of inflammation remains the primary concern for rheumatologists, but modern therapeutics have been largely effective, leaving structural damage and patient distress as more prominent issues among individual patients in routine patient care and Systematic quantitation may be critical to understand the effects of these problems on patient well being and limited responses to anti-inflammatory therapies.

« Back to 2018 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-importance-of-quantitative-assessment-of-joint-organ-damage-and-patient-distress-in-addition-to-inflammatory-activity-in-routine-clinical-care/