Dail Eireann debate. Written answer 191 - Pharmacy regulations [5945/06].

Objective. To investigate the reproducibility and validity of self-administered joint counts (JC), measuring tenderness, swelling and the combination of both, in a longitudinal study, Methods. At the outpatient department a form self-administered by patients (SAI-form), was used to measure joint involvement. Concurrent joint examinations were performed by an assessor. The JC and scores for groups of joints by assessors were correlated with those by patients. As a retest the form was completed again by the patients within 10 days. Correlations between the JC measured by the test and retest were computed to investigate reproducibility. Results. Correlations between test and retest were high (> 0.7), Correlations between JC and groups of joints measured by the assessors and by the patients were moderate (0.6), Correlations with other disease activity variables did not differ between assessors' and patients' joint examination scores. Conclusion. The patient-administered joint examination was reproducible; however, correlation with the assessors' joint examination was moderate. The value of the self-administered joint count needs further examination and cannot yet replace the assessor's joint examination

Influence of a ceiling effect on the assessment of radiographic progression in rheumatoid arthritis during the first 6 years of disease

Objective. To evaluate at what disease duration and to what extent a ceiling effect, due to reaching maximum scores for erosions (E) and/or joint space narrowing (JSN) in separate joints, started to influence the assessment of radiographic progression according to the modified method of Sharp, in patients with recent onset rheumatoid arthritis (RA). Methods. Prospective followup study of 87 patients with classical or definite RA, joint symptoms <1 year at study entry, Radiographs of hands and feet were made at study entry (Time 0), after 3 (T3), and after 6 years (T6) of followup. Assessment of radiographic progression according to the Van der Heijde modification of Sharp's method. The scores for E and JSN were analyzed separately in the individual groups of joints. Percentages of E joints, of joints with JSN, and of joints with maximum scores were assessed at TO. T3, and Tb. The relative risks for the development of radiographic damage and of maximum scores were assessed for the individual joints. An approximation of the magnitude of the ceiling effect was calculated. Results, After a disease duration of 6 years, a significant influence of a ceiling effect on the mean radiographic progression was found. Tn some individual patients the ceiling effect appeared to occur earlier. After 6 years, the maximum scores were distributed over 50% of the patients, and 20% of the patients had maximum scores in more than 10 joints without preference for specific localization. Conclusion. The ceiling effect appeared to be clinically relevant and should be taken into account when interpreting the effects of disease modifying antirheumatic drugs on radiographic progression in RA during the first years of the disease. Furthermore, it must be accounted for when describing the relationship between radiographic progression and process variables

Disease associated time consumption in early rheumatoid arthritis

Objective. To quantify the disease associated time consumption of normal activities of daily living and of treatment and monitoring activities in a cohort of patients with early rheumatoid arthritis (RA) with followup of at least 6 years. Comparison was made with a group of patients with asthma and chronic obstructive pulmonary disease (COPD). Methods. A prospective and retrospective inventory was carried out, by interview and record investigation, of RA related and RA unrelated items covering the period from the start of the disease. Interviews were also performed in a,group of patients with asthma and COPD. Results, For patients with RA there was a mean disease associated time consumption of at least 1.9 h/day during the first 6 years of the disease. The time consumption was mainly due to extra time needed for activities of daily living and daily disease related activities. Patients with the greatest progression of radiographic damage, with the most severe disability, and with the greatest cumulative disease activity had the greatest time consumption. For patients with asthma and COPD the consumption of time was comparable. Conclusion. RA is a time consuming disease. Recognition of the disease associated time consumption will have implications for work (dis)ability assessments in patients with chronic diseases such as RA