Validity and reliability of the twenty-eight-joint count for the assessment of rheumatoid arthritis activity

Smolen, Josef S.; Breedveld, F C; Eberl, Gérard; Jones, Ian; Leeming, M. R. G.; Wylie, Greg; Kirkpatrick, Julia

doi:10.1002/art.1780380106

Cited by 241 publications

(134 citation statements)

References 13 publications

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“…This study gives new methodologic support to earlier research showing that the reduced 28-joint counts can be useful for assessing baseline disease activity at a population level (e.g., as indicators of hospital performance or in clinical trials), but that more extensive joint counts might be preferable for following the disease course of the patients in daily clinical practice (5,23). Since foot joints, particularly the MTP joints, are commonly affected in RA (5), the main interest of this study was in the effect of the inclusion of forefoot joints on the measurement range and measurement precision of the joint count.…”

Section: Discussionsupporting

confidence: 70%

“…However, practical constraints, extra administration time, assessment difficulty, and the recognition that abnormalities in the feet may often result from processes other than RA are all reasons for their frequent exclusion from the joint counts (7)(8)(9)(10). Furthermore, various studies have shown that reduced joint counts that exclude the forefoot joints appear to be as reliable and valid as more comprehensive joint counts (1,5,7,11). Nevertheless, the exclusion of the forefoot joints remains a topic of debate and research.…”

Section: Introductionmentioning

confidence: 99%

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Contribution of assessing forefoot joints in early rheumatoid arthritis patients: Insights from item response theory

Siemons¹,

Klooster²,

Taal³

et al. 2013

Arthritis Care & Research

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Objective. To evaluate the contribution of assessing forefoot joints to the measurement range and measurement precision of joint counts in early rheumatoid arthritis (RA) using item response theory. Methods. Baseline measures of tender and swollen joint counts were analyzed in 459 early RA patients from the Dutch Rheumatoid Arthritis Monitoring remission induction cohort. The contribution of forefoot joints was studied by evaluating their effect on the measurement range and measurement precision of measures based on 28-joint counts. In addition, the alignment between the patient and joint distributions was investigated to determine whether the forefoot joints were informative for measuring joint tenderness or swelling of an early RA patient. Results. In total, 233 patients (50.76%) experienced tenderness and 200 patients (43.57%) experienced swelling in >1 forefoot joint. Forefoot joints were more informative for measuring joint tenderness than joint swelling, but did not significantly improve the measurement range and measurement precision of the 28-joint counts. Furthermore, including forefoot joints did not remove the existing discrepancy between the joint and patient distributions in both joint counts. Conclusion. Forefoot joints were frequently affected on an individual level, but did not significantly improve the measurement range or precision of 28-joint counts in patients with early RA. From a measurement perspective, reduced joint counts are appropriate for use on a population level. The contribution of assessing forefoot joints on an individual level requires further investigation. Additionally, the results should be cross-validated in patients with longer disease durations to determine whether the pattern of joint involvement is similar in later stages of RA.

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Section: Discussionsupporting

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Contribution of assessing forefoot joints in early rheumatoid arthritis patients: Insights from item response theory

Siemons¹,

Klooster²,

Taal³

et al. 2013

Arthritis Care & Research

View full text Add to dashboard Cite

show abstract

“…Disease activity was evaluated at baseline by the Disease Activity Score in 28 joints (DAS28) (37) in patients with RA and by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) (38) in patients with PsA and AS.…”

Section: Methodsmentioning

confidence: 99%

Safety of tumor necrosis factor α blockers in hepatitis B virus occult carriers (hepatitis B surface antigen negative/anti–hepatitis B core antigen positive) with rheumatic diseases

Caporali

Bobbio-Pallavicini

Atzeni

et al. 2010

Arthritis Care & Research

117

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“…Clinical assessments were performed at baseline and after 4, 12 (end of treatment phase), and 16 weeks, and included a 30-joint count (28-joint count [27] and both ankles) for joint swelling and tenderness, and physician and patient assessment of disease activity, morning stiffness, pain assessed by a visual analog scale (VAS), and serum levels of serum C-reactive protein (CRP). The clinical effect after treatment was calculated using the Disease Activity Score (DAS) (28), with CRP as the acute-phase reactant and 28 joints counted.…”

Section: Methodsmentioning

confidence: 99%

Alefacept treatment in psoriatic arthritis: Reduction of the effector T cell population in peripheral blood and synovial tissue is associated with improvement of clinical signs of arthritis

Kraan

Kuijk

Dinant

et al. 2002

Arthritis & Rheumatism

135

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Objective. To investigate whether alefacept (a fully human lymphocyte function-associated antigen 3 [LFA-3]/IgG1 fusion protein that blocks the LFA-3/CD2 interaction) is able to reduce the signs and symptoms of joint inflammation in patients with active psoriatic arthritis (PsA).Methods. Eleven patients with active PsA were treated with alefacept for 12 weeks in an open-label and explorative study. Clinical joint assessment and laboratory assessments were performed at baseline and after 4, 9, 12, and 16 weeks of treatment. Serial synovial tissue (ST) biopsy specimens from an inflamed index joint (knee, ankle, wrist, or metacarpophalangeal joint) were obtained by arthroscopy at baseline and after 4 and 12 weeks of treatment.Results. At the completion of treatment, 6 of 11 patients (55%) fulfilled the Disease Activity Score (DAS) response criteria. Nine patients (82%) fulfilled the DAS response criteria at any point during the study. There was a statistically significant reduction in CD4؉ lymphocytes (P < 0.05), CD8؉ lymphocytes (P ‫؍‬ 0.05), and CD68؉ macrophages (P < 0.02) in the ST after 12 weeks of treatment compared with baseline. The ST and peripheral blood of those patients fulfilling the DAS response criteria contained more CD45RO؉ cells at baseline and displayed a significant reduction in these cells compared with nonresponding patients.Conclusion. The changes in ST, together with the improvement in clinical joint scores, after treatment with alefacept support the hypothesis that T cell activation plays an important role in this chronic inflammatory disease. Furthermore, since alefacept, a T cellspecific agent, led to decreased macrophage infiltration, the data indicate that T cells are highly involved in synovial inflammation in PsA.

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Validity and reliability of the twenty-eight-joint count for the assessment of rheumatoid arthritis activity

Cited by 241 publications

References 13 publications

Contribution of assessing forefoot joints in early rheumatoid arthritis patients: Insights from item response theory

Contribution of assessing forefoot joints in early rheumatoid arthritis patients: Insights from item response theory

Safety of tumor necrosis factor α blockers in hepatitis B virus occult carriers (hepatitis B surface antigen negative/anti–hepatitis B core antigen positive) with rheumatic diseases

Alefacept treatment in psoriatic arthritis: Reduction of the effector T cell population in peripheral blood and synovial tissue is associated with improvement of clinical signs of arthritis

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