FRI0678 Validity of three 0–10 visual analog scales (VAS) for quantitative physician assessment of inflammation, damage, and distress to supplement a physician global assessment 0–10 vas
Authors: T. Pincus, I. Castrejon, J. A. Block
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background:</h3> Rheumatologists generally view their primary goal as control of inflammation in order to prevent long-term damage, and quantitative assessment involves measures of inflammatory activity (lab tests, joint counts, and indices). Although structural damage and patient distress (fibromyalgia, depression, etc.) are widely recognized, these problems generally are described narratively, and not assessed quantitatively. Recent advances in control of inflammation, as well as increased degenerative diseases in an aging population and recognition of a high prevalence of fibromyalgia, may have shifted rheumatologists9 patient mix more prominently toward damage and distress vs inflammation. <h3>Objectives:</h3> To analyze physician global assessment (DOCGL) on a 0–10 visual analog scales (VAS), and 3 additional 0–10 VAS for inflammation, damage, and distress, as well as estimates of the proportion of each to explain DOCGL. <h3>Methods:</h3> Rheumatologists at one academic site complete a 0–10 DOCGL VAS, 3 further 0–10 VAS to assess inflammation (reversible disease) (DOCINF), joint and other organ damage (irreversible disease) (DOCDAM), and patient distress (fibromyalgia, depression), etc. (DOCSTR), in routine care. The proportion of DOCGL attributed to inflammation, damage, and distress (total=100%) also is estimated. Mean values were analyzed in a cross-sectional study of 570 patients, and compared in subgroups with rheumatoid arthritis (RA), osteoarthritis (OA), or fibromyalgia (FM), using t tests and analysis of variance (ANOVA). <h3>Results:</h3> Mean DOCGL VAS was 4.4/10 in all patients, 4.4 in 131 with OA, 4.6 in 98 with RA, and 5.2 in 89 with FM (table 1). Highest mean scores were seen for DOCINF in RA, DOCDAM in OA, and DOCSTR in FM (p&lt;0.001), indicating face validity. Nonetheless, mean DOCDAM was higher than DOCINF in all groups, including RA, and mean estimates of the proportion of DOCGL attributed to damage was greater than to inflammation in all groups (table 1). Scores for DOCSTR were higher than for DOCINF in all groups other than RA. <h3>Conclusions:</h3> VAS scores and estimates of the proportions of DOCGL attributed to damage were higher than for inflammation in all groups, including RA patients as a group. Control of inflammation remains a primary concern for rheumatologists, but has improved considerably in recent years, and damage and distress may have become more prominent in routine care. Systematic quantitation of inflammation, damage, and distress, in addition to DOCGL, appears feasible and of value in routine clinical care. <h3>Disclosure of Interest:</h3> T. Pincus Shareholder of: Dr. Pincus holds a copyright and trademark for MDHAQ and RAPID3 for which he receives royalties and license fees. All revenue is used to support further development of quantitative questionnaire measures for patients and doctors in clinical rheumatology care., I. Castrejon: None declared, J. Block: None declared