Daily Rheumatology Research Articles

Schmerzmessung in der Rheumatologie

Pain is the leading symptom and as well the main complaint of most patients with rheumatic diseases. Thus, assessment of pain is essential for monitoring disease activity and therapy response. Pain can be assessed with one-dimensional tools such as numeric rating scales or visual analogue scales. Both are more powerful in detecting changes in pain intensity than a verbal categorical rating scale and are widely used in clinical trials as well as in daily routine care. Any assessment of pain must take into account other factors, such as cognitive impairment or dementia, and assessment tools validated in the specific disease and patient groups being studied. Chronic rheumatic pain assessment and its impact on physical, emotional, and social functions requires more sophisticated multidimensional qualitative tools. Due to various reasons their use is not established in daily clinical rheumatology although they demonstrate therapeutic impact if used appropriately.

Angiographic sign of good prognosis for hemiplegia in hypertensive intracerebral hemorrhage.

<h3>Objective</h3> Rheumatologists play a pivotal role in the management of patients with psoriatic arthritis (PsA). Due to time constraints during clinic visits, the skin may not receive the attention needed for optimal patient outcome. Therefore, the aim of this study was to select a set of core questions that can help rheumatologists in daily rheumatology clinical practice to identify patients with PsA with a high skin burden. <h3>Methods</h3> Baseline data from patients included in the Dutch South West Psoriatic Arthritis (DEPAR) cohort were used. Questions were derived from the Skindex-17 and Dermatology Life Quality Index (DLQI) questionnaires. Underlying clusters of questions were identified with an exploratory principal component analysis (PCA) with varimax rotation, after which a 2-parameter logistic model was fitted per cluster. Questions were selected based on their discrimination and difficulty. Subsequently, 2 flowcharts were made with categories of skin burden severity. Clinical considerations were specified per category. <h3>Results</h3> In total, 413 patients were included. The PCA showed 2 underlying clusters: a psychosocial domain and a domain assessing physical symptoms. We selected these 2 domains. The psychosocial domain contains 3 questions and specifies 4 categories of skin burden severity. The physical symptoms domain contains 2 questions and categorizes patients in 1 out of 3 categories. <h3>Conclusion</h3> We have selected a set with a maximum of 5 questions that rheumatologists can easily implement in their consultation to assess skin burden in patients with PsA. This practical guide makes the assessment of skin burden more accessible to rheumatologists and can aid in clinical decision making.