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Sometimes Patients are Best Gauge of Arthritis Treatments

New questionnaire proves valuable to doctors

WEDNESDAY, March 26, 2003 (HealthDayNews) -- What's the best way for doctors to know if an arthritis medication is working?

Ask the patient.

That's the simple but important conclusion of a new, multi-center study that compared the effectiveness of a patient questionnaire to a laundry list of clinical observations and tests.

"Oftentimes it's the most simple things in medicine that produce the best results. And that seems to be the case when figuring out what works and what doesn't for these patients," says Dr. Theodore Pincus, lead author of the study that appears in the April issue of Arthritis and Rheumatism.

Although there's no universally accepted system of assessing a patient's response to treatments for rheumatoid arthritis, the most accepted method is a criteria established by the American College of Rheumatology for use during clinical trials of a drug.

Known as the ACR20, the criteria involves seven sets of measures that include detailed clinical observations of a patient's condition, including joint size and degree of swelling, as well as some detailed laboratory tests.

As good as the system can be, it is complicated, costly and time-consuming, and, doctors say, in many respects has little relevance in a clinical setting.

"The more complicated things get in assessing a patient's condition, the more room for error there is, particularly when the examination involves multiple joint measurements," says Pincus, a professor of medicine at Vanderbilt University in Nashville, where some of research took place.

The solution, Pincus says, may lie in one-page questionnaire to be filled out not by doctors, but by rheumatoid arthritis patients themselves, as they sit in their doctor's waiting room. The questions, which were adapted from the ACR20, focus on specific signs that predict how well a drug is working --- including a patient's overall well-being, level of pain and quality of life.

"We ask a patient, 'Can you turn on the faucet? How hard is it to open a door knob? Can you get in and out of your car?' The answers to these kinds of questions are much more meaningful when it comes to figuring out how this patient is really doing, in real life," says Pincus.

For Dr. Steven B. Abramson, the study represents a step forward in the standardization of diagnostic criteria that could ultimately help ensure that rheumatoid arthritis patients get the most out of their medical care.

"The ACR20 is an excellent criteria, but it really was not developed for clinical use, so it's not really that useful in a clinical setting," says Abramson, director of rheumatology at New York University Medical Center.

By streamlining the diagnostic criteria and allowing for a standardized system of assessing a patient's condition, Abramson believes the new questionnaire holds great promise for more efficient -- and maybe even less costly -- care.

"It would also be a big help in, for example, justifying to insurance companies why a particular patient may need a more expensive drug. The questionnaire would make it easy to show what works and what doesn't. And it's easy for everyone to interpret and understand," Abramson says.

The study looked at 480 patients diagnosed with rheumatoid arthritis, each of whom filled out the one-page questionnaire prior to having any treatment. The patients were then divided into three groups, with each one taking either a placebo, or one of the two arthritis medications known as leflunomide or methotrexate. At various intervals, their progress was monitored using either the more complicated ACR20 system or the new one-page questionnaire.

The end result: The questionnaire was shown to be as accurate as the ACR20 in predicting the effectiveness of the medications. And it was equally effective at pinpointing quality of life issues affected by the disease and aided by the medications.

While Abramson says he's not certain doctors will implement the new questionnaire into their practice immediately, he believes it's "an important option worth considering."

More information

To learn more about rheumatoid arthritis, visit the The Arthritis Foundation or the National Institutes of Health.

SOURCES: Theodore Pincus, M.D., professor, medicine, Division of Rheumatology/Immunology, Vanderbilt University Medical Center, Nashville, Tenn.; Steven B. Abramson, M.D., director, rheumatology, New York University Medical Center and the Hospital for Joint Diseases, and professor, New York University School of Medicine, New York City; April 2003 Arthritis and Rheumatism
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