Inflammation Is More Prominent Than Joint Damage at Initial Visits of Patients with Inflammatory Arthritides, but Organ Damage and Patient Distress Are as Prominent in Overall Rheumatology Care: Data from a Feasible Physician RheuMetric Checklist

Background Patients consult rheumatologists for symptoms which may result from inflammatory activity (INF), joint or other organ damage (DAM) and/or distress (STR), e.g., fibromyalgia, depression. However, quantitative assessment in routine rheumatology care is directed primarily (often exclusively) to INF, e.g., DAS28, CDAI, SLEDAI, ASDAS, and DAPSA. DAM and STR are recognized in many patients, but generally recorded only as narrative descriptions, rather than as quantitative data. INF indices function effectively in clinical trials, but measures and indices designed to assess INF may be elevated in many unselected routine care patients by comorbid DAM and/or STR, often despite little or no INF. A RheuMetric checklist includes 4 0-10 visual numeric scales (VNS) for physician global assessment (DOCGL), DOCINF, DOCDAM, and DOCSTR, and estimates of the % of DOCGL attributed to INF, DAM, and STR. Objectives To analyze RheuMetric scores in unselected routine care patients with all diagnoses at initial or return visits to an academic rheumatology setting. Methods A retrospective cross-sectional study was performed of RheuMetric checklist 0-10 VNS estimates for DOCGL and estimates of %INF, %DAM, and %STR (total=100%) completed in routine care by the treating rheumatologist. Mean levels of these estimates were analyzed according to primary diagnosis, classified as INF (RA, SLE, SpA, vasculitis and gout), osteoarthritis (OA), primary fibromyalgia (FM), and “other,” at initial or return visits, using descriptive and chi-square statistics. Results Highest DOCINF was in inflammatory diseases, DOCDAM in OA, and DOCSTR in primary FM (Table 1). The % of DOCGL attributed to INF, DAM, and STR was highest in INF diseases, OA, and primary FM, respectively (p<0.001) (Table 1). At initial visits of patients with INF, mean DOCGL was 4.3, attributed 62% to INF, 24% to DAM and 14% to STR, respectively; at return visits, DOCGL was 3.7, attributed 33% to INF, 49% to DAM and 18% to STR (Table 1). In patients with all diagnoses, 36%, 36%, and 28% of DOCGL were attributed to INF, DAM, and STR, respectively, at first visits, vs 22%, 51%, and 28% at return visits (Table 1). RheuMetric estimates required 15-20 seconds to complete. Conclusion RheuMetric physician estimates for INF, DAM, and STR are feasibly assessed in routine care, with face validity documented by significantly higher INF in inflammatory diseases, DAM in OA, and STR in FM. DOCINF was higher at first vs return visits, reflecting highly effective anti-inflammatory treatments at this time, while %DOCDAM rose. At return visits, INF accounted for 22% of DOCGL vs 50% for DAM and 28% for STR, indicating that control of inflammation is not the primary activity in overall rheumatology care after the first visit. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests None Declared.