Peter P Cheung1, Manjari Lahiri2, Gim Gee Teng2, Anita Y N Lim2, Tang Ching Lau2, Aisha Lateef2, Anselm Mak2, Laure Gossec3, Lyn March3. 1. Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore, Yong Loo Lin School of Medicine, National University of Singapore, Institute of Bone and Joint Research, University of Sydney, Sydney, NSW, Australia and UPMC University Paris 06, GRC-UPMC 08 (EEMOIS), AP-HP, Pitié-Salpêtrière Hospital, Department of Rheumatology, Paris, France Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore, Yong Loo Lin School of Medicine, National University of Singapore, Institute of Bone and Joint Research, University of Sydney, Sydney, NSW, Australia and UPMC University Paris 06, GRC-UPMC 08 (EEMOIS), AP-HP, Pitié-Salpêtrière Hospital, Department of Rheumatology, Paris, France Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore, Yong Loo Lin School of Medicine, National University of Singapore, Institute of Bone and Joint Research, University of Sydney, Sydney, NSW, Australia and UPMC University Paris 06, GRC-UPMC 08 (EEMOIS), AP-HP, Pitié-Salpêtrière Hospital, Department of Rheumatology, Paris, France peter_cheung@nuhs.edu.sg. 2. Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore, Yong Loo Lin School of Medicine, National University of Singapore, Institute of Bone and Joint Research, University of Sydney, Sydney, NSW, Australia and UPMC University Paris 06, GRC-UPMC 08 (EEMOIS), AP-HP, Pitié-Salpêtrière Hospital, Department of Rheumatology, Paris, France Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore, Yong Loo Lin School of Medicine, National University of Singapore, Institute of Bone and Joint Research, University of Sydney, Sydney, NSW, Australia and UPMC University Paris 06, GRC-UPMC 08 (EEMOIS), AP-HP, Pitié-Salpêtrière Hospital, Department of Rheumatology, Paris, France. 3. Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore, Yong Loo Lin School of Medicine, National University of Singapore, Institute of Bone and Joint Research, University of Sydney, Sydney, NSW, Australia and UPMC University Paris 06, GRC-UPMC 08 (EEMOIS), AP-HP, Pitié-Salpêtrière Hospital, Department of Rheumatology, Paris, France.
Abstract
OBJECTIVE: Patients can potentially monitor disease activity of RA through self-assessed swollen joints (clinical synovitis), but reliability is poor. The objective is to evaluate the use of education by US feedback on the ability of patients to assess for clinical synovitis in RA. METHODS: We performed a 6 month, single-centre, randomized controlled trial on patients with established RA to study the effect of education on self-assessment of joints that included initial brief patient training on tender (TJC) and swollen (SJC) joint counts followed by US feedback every 3 months vs standard care without education. Patient and physician independently performed 28-joint counts at each visit. Outcome variables included the percentage of patients with good agreement with physician-derived swollen joints [prevalence-adjusted bias-adjusted kappa (PABAK) >0.6] as well as agreement in the SJC (Bland and Altman 95% limits of agreement), feasibility/patient satisfaction survey and disease activity at 6 months. RESULTS: Of the 101 randomized patients, 95 were included (51 in the education arm and 44 in the standard care arm). At 6 months there was a significant difference in the proportion of patients with swollen joint PABAK >0.6 in the education arm compared with standard care (98 vs 85%, P = 0.02). Limits of agreement for the SJC difference between physician and patients were reduced only in the education arm. The training method is considered feasible, with 94% of patients reporting it as useful. A trend of higher rates of disease remission (28-joint DAS <2.6) in the education arm vs standard care (47% vs 29%, P = 0.07) was seen. CONCLUSION: A short course of education with US feedback may be helpful in educating patients to assess for clinical synovitis. TRIAL REGISTRATION: Clinical trials.gov, https://clinicaltrials.gov, NCT02351401.
RCT Entities:
OBJECTIVE:Patients can potentially monitor disease activity of RA through self-assessed swollen joints (clinical synovitis), but reliability is poor. The objective is to evaluate the use of education by US feedback on the ability of patients to assess for clinical synovitis in RA. METHODS: We performed a 6 month, single-centre, randomized controlled trial on patients with established RA to study the effect of education on self-assessment of joints that included initial brief patient training on tender (TJC) and swollen (SJC) joint counts followed by US feedback every 3 months vs standard care without education. Patient and physician independently performed 28-joint counts at each visit. Outcome variables included the percentage of patients with good agreement with physician-derived swollen joints [prevalence-adjusted bias-adjusted kappa (PABAK) >0.6] as well as agreement in the SJC (Bland and Altman 95% limits of agreement), feasibility/patient satisfaction survey and disease activity at 6 months. RESULTS: Of the 101 randomized patients, 95 were included (51 in the education arm and 44 in the standard care arm). At 6 months there was a significant difference in the proportion of patients with swollen joint PABAK >0.6 in the education arm compared with standard care (98 vs 85%, P = 0.02). Limits of agreement for the SJC difference between physician and patients were reduced only in the education arm. The training method is considered feasible, with 94% of patients reporting it as useful. A trend of higher rates of disease remission (28-joint DAS <2.6) in the education arm vs standard care (47% vs 29%, P = 0.07) was seen. CONCLUSION: A short course of education with US feedback may be helpful in educating patients to assess for clinical synovitis. TRIAL REGISTRATION: Clinical trials.gov, https://clinicaltrials.gov, NCT02351401.