Project Details
Description
Introduction: Rheumatoid arthritis (RA) is characterized by joint inflammation and pain and can lead to joint destruction, reduced range of motion, functional limitation, decreased quality of life, and increased risk of death. The evaluation of RA activity is based on physical examination of each joint. However, joint examination is not standardized, and the techniques are variable and difficult to reproduce because of disagreement between examiners. Our objective was to propose recommendations for a standardized joint examination technique based on the RAND Corporation and the University of California, Los Angeles (RAND/UCLA) Appropriateness Method. Methods: We used the RAND/UCLA Appropriateness Method to conduct a systematic literature review to determine key elements of a joint examination for patients with RA. We combined this research with rheumatology expert consensus to propose recommendations. The RA diagnosis and differential diagnosis were disregarded. Results: A total of 215 rheumatologists were invited to participate in this study. Of those who accepted the invitation, five were included in the core panel and 26 were included in the panel of clinical experts. Panel members' ages ranged from 35-72 years (median: 45 years; interquartile range: 42-65) and clinical experience from 2 to 25 years (mean 15.6 years; standard deviation 6.3 years). Most rheumatologists participated in all rounds (Round 1: 100%; Round 2: 61%; Round 3: 61%). Out of 51 statements on a questionnaire about examination techniques, 33 regarding two RA activity issues were deemed appropriate. Conclusion and relevance: The physical examination techniques that determine RA activity are heterogeneous and differ markedly in several characteristics. A list of recommendations derived from a RAND/UCLA consensus exercise is proposed as a guide to improve and standardize the method of physical examination of joints. This standardization will improve diagnosis and outcomes for patients with RA and help clinicians provide better treatment.
Status | Finished |
---|---|
Effective start/end date | 03/06/22 → 02/02/23 |