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A randomized controlled trial for improving patient self-assessment of synovitis in rheumatoid arthritis with education by ultrasonography: the RAEUS Study

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 perfo... Full description

Journal Title: Rheumatology 2015, Vol. 54(7), pp.1161-1169
Main Author: Cheung, Peter P
Other Authors: Lahiri, Manjari , Teng, Gim Gee , Lim, Anita Y. N , Lau, Tang Ching , Lateef, Aisha , Mak, Anselm , Gossec, Laure , March, Lyn
Format: Electronic Article Electronic Article
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ID: ISSN: 1462-0324 ; E-ISSN: 1462-0332 ; DOI: 10.1093/rheumatology/keu447
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title: A randomized controlled trial for improving patient self-assessment of synovitis in rheumatoid arthritis with education by ultrasonography: the RAEUS Study
format: Article
creator:
  • Cheung, Peter P
  • Lahiri, Manjari
  • Teng, Gim Gee
  • Lim, Anita Y. N
  • Lau, Tang Ching
  • Lateef, Aisha
  • Mak, Anselm
  • Gossec, Laure
  • March, Lyn
subjects:
  • Synovitis
  • Rheumatoid Arthritis
  • Joint Counts
  • Self - Report
  • Ultrasonography
ispartof: Rheumatology, 2015, Vol. 54(7), pp.1161-1169
description: 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
language:
source:
identifier: ISSN: 1462-0324 ; E-ISSN: 1462-0332 ; DOI: 10.1093/rheumatology/keu447
fulltext: fulltext
issn:
  • 1462-0324
  • 14620324
  • 1462-0332
  • 14620332
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titleA randomized controlled trial for improving patient self-assessment of synovitis in rheumatoid arthritis with education by ultrasonography: the RAEUS Study
creatorCheung, Peter P ; Lahiri, Manjari ; Teng, Gim Gee ; Lim, Anita Y. N ; Lau, Tang Ching ; Lateef, Aisha ; Mak, Anselm ; Gossec, Laure ; March, Lyn
ispartofRheumatology, 2015, Vol. 54(7), pp.1161-1169
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subjectSynovitis ; Rheumatoid Arthritis ; Joint Counts ; Self - Report ; Ultrasonography
descriptionObjective. 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.
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titleA randomized controlled trial for improving patient self-assessment of synovitis in rheumatoid arthritis with education by ultrasonography: the RAEUS Study
description
0Objective. 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.
1Methods. 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.
2Results. 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.
3Conclusion. A short course of education with US feedback may be helpful in educating patients to assess for clinical synovitis.
4Trial registration: Clinical trials.gov, https://clinicaltrials.gov , NCT02351401.
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abstractObjective. 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.
pubOxford University Press
doi10.1093/rheumatology/keu447
date2015-07