|Title:||The Reliability Of Joint Count Assessment In Rheumatoid Arthritis|
|Authors:||Cheung, Peter Pak Moon|
|Publisher:||University of Sydney.|
Faculty of Medicine.
Northern Clinical School.
Institute of Bone and Joint Research.
|Abstract:||Background: Optimal management of rheumatoid arthritis relies on treating to target and tight control of disease activity through accurate and regular identification of synovitis as part of disease activity monitoring. Joint counts (tender and swollen joints) have traditionally been used for assessment of disease activity. However, the reliability of joint counts, particularly, the swollen joint count has been questionable. Objectives: To evaluate the reliability of joint counts, particularly the swollen joint count, derived by physicians, nurses as well as patients, and investigate ways to improve this. Methods: Reliability of tender and swollen joints was evaluated cross-sectionally between physician, nurse and patients, with ultrasound as the reference standard. This was followed by consensus exercises studying whether physicians can improve swollen joint agreement. A short training program then evaluated the learning curve of nurses, followed by a randomized controlled study using ultrasound as a training tool for patients to learn how to evaluate for synovitis. Results: Although the studies confirmed that physicians, nurses, and in particular, patients, had poor reliability especially for swollen joints, potential improvements in reliability through short training consensus exercises among physicians and also nurses can occur. In addition, patients can improve synovitis assessment through education of self-assessed joint counts using ultrasound as a training tool. Improvements were observed particularly in patients with lower levels of disease activity. Conclusion: Reliability of joint counts remain a significant issue, particularly that derived by patients, and require further evaluation before it will be clinically useful.|
|Rights and Permissions:||The author retains copyright of this thesis. It may only be used for the purposes of research and study. It must not be used for any other purposes and may not be transmitted or shared with others without prior permission.|
|Type of Work:||PhD Doctorate|
|Type of Publication:||Doctor of Philosophy Ph.D.|
|Appears in Collections:||Sydney Digital Theses (University of Sydney Access only)|
|CHEUNG Peter Pak Moon - Final thesis.pdf||Thesis||25.84 MB||Adobe PDF|
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