Abstract
BackgroundRecent qualitative research has shown that stiffness is an important symptom for patients to identify remission. However, it is unclear how to measure stiffness in low disease activity. This systematic review aims to summarise the existing literature on validity of patient reported outcomes to measure stiffness in RA low disease activity states, to aid the choice for a measurement instrument.MethodsAn extensive pubmed-search was undertaken, identifying measurement instruments for patient perceived stiffness used in low disease activity. Eligible studies reported on 1) stiffness as an outcome in relation to other core set measures, 2) development of a patient reported tool to measure stiffness, or 3) comparison of two different tools to measure aspects of stiffness, all in low disease activity.ResultsOf 788 titles, only two studies report on validity of stiffness measures within low disease activity. Morning stiffness (MS) is reported in 44 to 80% of patients in low disease activity. A difference of 40 to 60 minutes in duration until maximum improvement is observed between active and inactive patients. Severity of MS might discriminate better between high and low disease activity compared to measurement of duration of MS.ConclusionsThere is insufficient data on measurement of stiffness in the spectrum of low disease activity or remission.
Highlights
Recent qualitative research has shown that stiffness is an important symptom for patients to identify remission
With the current systematic review, we aim to summarise the existing literature on validity of patient reported outcomes to measure stiffness in rheumatoid arthritis (RA) low disease activity or remission, to aid the choice for a measurement instrument
This review identified 2 studies that investigated measures of stiffness in RA low disease activity states, both focussed on morning stiffness
Summary
Recent qualitative research has shown that stiffness is an important symptom for patients to identify remission. It is unclear how to measure stiffness in low disease activity. This systematic review aims to summarise the existing literature on validity of patient reported outcomes to measure stiffness in RA low disease activity states, to aid the choice for a measurement instrument. Symptoms that follow the circadian rhythm like joint stiffness and pain are most severe in the early mornings [2]. Duration of MS was part of the American classification criteria for RA [3] It was excluded from the recent update, as it was felt the instruments to measure it yielded data of insufficient reliability to include stiffness in the classification criteria [4,5,6,7,8,9]. Still, impaired morning function as a result of MS has considerable impact on the Clearly, stiffness, either in the morning or during the day, is an important aspect of RA disease activity
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