AB0307 A.P.R.A.N. ASSESSMENTS OF TENDER AND SWOLLEN JOINTS COUNT SCORE PERFORMED BY A RHEUMATOLOGIST AND RHEUMATOLOGY NURSES IN PATIENTS WITH RHEUMATOID ARTHRITIS AND PSORIATIC ARTHRITIS
Authors: Isabelle Fortin, Nabil Chaker, Frederic Banville, Faye Wetherall
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Rheumatoid arthritis (RA) is a multisystem and debilitating disease. Fortunately, there is now a wide range of available treatments for these patients<sup>2</sup>. Also, guidelines recommend a « treat to target »<sup>1</sup> involving strict follow-up of the patients. The recommended target is remission. But, in Canada, especially in rural areas, there are few rheumatologists facing a growing number or RA patients. Innovative solutions are needed in order to face this challenge. One solution is to work with a nurse assistant performing the joint count evaluation between the rheumatologist's visits. The consistency of examinations and disease activity evaluation is therefore. <h3>Objectives</h3> The primary objective is to validate the accuracy of the assessment of RA and Psoriatic arthritis disease activity by a nurse in comparison to assessments conducted by rheumatologists for CDAI and DAS-28. The secondary objective is to validate the accuracy of different parts of the CDAI and DAS-28. Comparison with the patient's joint count is done as well. <h3>Methods</h3> The trial was conducted in a private clinic. The patient was examined at first by the physician and afterward by the nurse. The 2 nurses participating to the trial were trained for joint count during a 14 hours course. Finally, a brief training was given to the patient who performed a self-evaluation. The study consisted of one visit where all the different information was collected. The different data collected concerned: the patient's medical history, medication, diagnostic, joint count by the nurse and the physician, VAS by nurse and physician. The patient's self-joint count was done for a subgroup of the patients. The Rho of Spearman was used for the correlation analysis. <h3>Results</h3> The overall correlation between the patient DAS-28 and physician DAS-28 was good (r=0,701) and it was very good between the nurse and the physician (r=0,846).The correlation between the nurse CDAI and the physician CDAI was also very good (r=0,765). The correlation between the different parts of the DAS-28 was less impressive. But in the same way, the correlation was better between the nurse (nr) and the physician, than between the patient (pt) and the physician (MD) and the least between the patient and the nurse. Respectively the correlation for TJC pt-nr is r=0,452, pt-MD is r=0,537, nr-MD is r=0,693, for the SJC the correlation is with pt-nr=0,390, pt-MD=0,414, nr-MD=0,699. The VAS-pt correlates poorly with both the nurse and the doctor VAS, respectively r=0,428 and r=0,392.No significant difference was found between the two nurses. <h3>Conclusion</h3> The primary end point is attained. There is a very good correlation between the nurse and the physician's evaluation. These results are congruent with those of previous studies<sup>3</sup>. So, this study is another argument to work with a nurse assistant and to use DAS-28 or CDAI in order to save time as we can be confident that the results of the nurse examination is accurate and valuable. This team work is a way to improve patient care following the guidelines. Treat to Target is possible even in remote areas lacking of resources. <h3>References</h3> [1] Smolen JS, et al. Treating rheumatoid arthritis to target: recommendations of an international task force; Ann Rheum Dis 2010; 69: 631-6372- Anderson, et al., Rheumatoid Arthritis Disease Activity Measures: American College of Rheumatology Recommendations for Use in Clinical Practice; Arthritis Care &amp; Research, Vol. 64, No 5, May 2012, pp 640-6473-Cheung PP, Gossec L, Mak A, March L. Reliability of joint count assessment in rheumatoid arthritis: A systematic literature review. Semin Arthritis Rheum. 2014 Jun;43(6):721-9. <h3>Acknowledgement</h3> Investigator Initiated study supported by Jannsen. <h3>Disclosure of Interests</h3> Isabelle Fortin Grant/research support from: ABBVIE, AMGEN, ASTRAZENECA, BMS, GSK, JANSSEN, PFIZER, SANOFI, UCB, Consultant for: LILLY, NOVARTIS, SANOFI, Speakers bureau: NOVARTIS, PFIZER, Nabil Chaker Grant/research support from: Jannsen, UCB, AMGEN, ABBVIE, PFIZER, SANOFI, Frederic Banville: None declared, Faye Wetherall: None declared