Limitations of a quantitative swollen and tender joint count to assess and monitor patients with rheumatoid arthritis

Abstract

A quantitative count of swollen and tender joints is a primary measure to assess patients with rheumatoid arthritis (RA), and is weighted of higher value than the other 5 Core Data Set measures in all indices in which it is included. However a number of limitations of the swollen and tender joint count have been described in the rheumatology literature, including poor reproducibility, with a requirement to be performed by the same observer at each visit; likelihood to improve with placebo treatment as much or more than the other 5 RA Core Data Set measures in clinical trials; similar or lower relative efficiencies than global and patient measures to document differences between active and control treatments in clinical trials; improvement over 5 years in clinical care, while joint damage and functional disability may progress; and lower sensitivity to detect inflammatory activity than ultrasound. Most visits to a rheumatologist do not include a formal quantitative joint count. It may be suggested that a careful qualitative joint count, supplemented by quantitative patient self-report questionnaire scores, may be more than adequate to monitor and document changes in patient status in busy clinical settings.