Validation of patient-reported joint counts in rheumatoid arthritis and the role of training

Objective. To demonstrate the effectiveness of simple training on improving the ability of patients with rheumatoid arthritis (RA) to assess joint swelling, and to validate the use of a computerized questionnaire, the Health Assessment Questionnaire (HAQ-ulous), to collect patient-reported tender and swollen joint counts. Methods. Sixty patients completed the HAQ-ulous, reporting pain and swelling of the 28 joints included in the Disease Activity Score-28. A rheumatologist blinded to the patients' responses assessed each joint for the presence of tenderness and swelling. At followup visits, 30 patients received training in distinguishing a swollen joint from a chronically enlarged joint, completed the HAQ-ulous again, and were reassessed by the physician. Results. At the initial visit, a strong correlation was shown between patient- and clinician-reported tender joints [Pearson correlation coefficient (r(p)) = 0.79; p < 0.0001]. Correlation between patient- and clinician-reported swollen joints was less robust (r(p) = 0.41; p = 0.001). Following training at the second visit, agreement between patients and the clinician improved for both tender joints (r(p) = 0.94; p < 0.0001) and swollen joints (r(p) = 0.93; p < 0.0001). Conclusion. With simple training in distinguishing swollen joints from chronically enlarged joints, the majority of patients are able to accurately assess joint swelling. Objective tools, such as the HAQ-ulous, that incorporate patient-reported outcomes are a valuable and reliable addition to standard clinical practice for monitoring patients with RA.