RheuMetric: A physician checklist to record patient levels of inflammation, damage and distress as quantitative data rather than as narrative impressions

Background: A physician global estimate of patient status (DOCGL) was designed to quantitate inflammatory activity but may be influenced by the presence of damage and distress. Therefore, three additional 0 to 10 visual analog scales (VAS) have been developed on a RheuMetric checklist to record physician estimates of inflammation (DOCINF), damage (DOCDAM), and distress (DOCSTR) (such as fibromyalgia and somatization). We analyzed patient scores on a multidimensional health assessment questionnaire (MDHAQ) and four RheuMetric physician estimates in patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), osteoarthritis (OA), and fibromyalgia (FM). Methods: All patients with all diagnoses seen by Rush University Medical Center rheumatologists complete an MDHAQ and have four RheuMetric 0 to 10 VAS estimates for DOCGL, DOCINF, DOCDAM, and DOCSTR assigned by the rheumatologist at each visit. A random visit of 205 patients with RA (N = 50), OA (N = 67), SLE (N = 66), and FM (N = 32) was analyzed for mean MDHAQ scores, RheuMetric estimates, and Spearman correlations. Results: Mean MDHAQ scores and DOCGL were highest for FM, followed by OA, RA, and SLE. Highest estimates and highest correlations with DOCGL were seen for DOCINF in RA, for DOCDAM in OA, and for DOCSTR in FM. DOCDAM estimates were higher than DOCINF in RA and SLE, suggesting that damage may be as severe a clinical problem as inflammation. DOCGL was correlated significantly with patient global estimate (PATGL) in RA, SLE, and OA, but not in FM. Conclusions: Physician estimates for inflammation, damage, and distress differ in different rheumatic diagnoses. Many patients have inflammation and damage or distress, or all three problems, reflecting challenges of rheumatology care.