Meaning of patient global assessment when joint counts are low in rheumatoid arthritis

Objective: In patients with rheumatoid arthritis (RA) with low 28-joint tender and swollen joint counts but who assessed their disease as active, to evaluate whether activity reflected RA symptoms.

Methods: We carried out a cross-sectional study of patients in BRASS, a cohort of patients with established RA who had 28-joint counts assessed, scored their disease activity, identified their painful joints, and answered questions about other sites of pain and fatigue. Patients and their rheumatologists were asked about the presence of fibromyalgia. We examined whether patients reported pain in joints excluded from the 28-joint joint count (feet, ankles, hips, neck) and pain or symptoms probably unrelated to RA including low back pain, headache and fibromyalgia. Fatigue was not classified. Analyses were descriptive.

Results: Of 272 patients, 49 had tender and swollen joint counts <1 and a patient global assessment score of ≥3/10. 48/49 (95%) reported pain in joints excluded from the 28-joint count. Of these 49, 24 (45%) also had other symptoms especially low back pain. Fatigue was present in all patients. No patient had fibromyalgia.

Conclusion: If joint counts <=1 are scored in 28 joints, patient global assessments of ≥3/10 often occur when there is pain in uncounted joints, joints that may respond to RA treatment.