Perceived Disease Activity Research Articles

Quality of a Supporting Mobile App for Rheumatic Patients: Patient-Based Assessment Using the User Version of the Mobile Application Scale (uMARS).

Introduction: Mobile applications promise to improve current health care. However, current mobile app quality ratings are mostly physician-based. The aim of this study was (1) to assess the quality of the self-management app Rheuma Auszeit using the validated uMARS (User Version of the Mobile App Rating Scale) app quality assessment tool and (2) to evaluate the association between uMARS scores and patients' characteristics.Materials and Methods: Consecutive patients with rheumatoid arthritis, psoriatic arthritis and spondyloarthritis were seen at the rheumatology clinic at university hospital Erlangen, Germany. They were asked to test Rheuma Auszeit, evaluate its quality using uMARS and complete a paper-based survey evaluating the individual preferences, attitudes and ehealth literacy. The association between uMARS scores and patients' characteristics was further explored.Results: Between December 2018 and January 2019, a total of 126 patients evaluated Rheuma Auszeit using uMARS and filled out the paper-based survey. The median uMARS score was 3.9, IQR 0.7. Functionality was the domain with the highest rating (median 4.8, IQR 0.8), followed by aesthetics (median 4.0, IQR 0.7), information (median 3.5, IQR 0.8), and engagement (median 3.2, IQR 1.0). Subjective quality was average (median 3.0, IQR 1.0). The lowest scoring individual item was customization with a median of 2.5/5. Lower functionality scores were reported among older female rheumatic patients (P < 0.004). Older male rheumatic patients reported a higher subjective quality score (P < 0.024). Perceived disease activity and disease duration did not significantly correlate with any uMARS subdomain scores. eHealth literacy significantly correlated with functionality uMARS subdomain ratings (Rho = 0.18; P < 0.042). Preferred time of app usage significantly correlated with engagement (Rho = 0.20; P < 0.024), functionality (Rho = 0.19; P < 0.029), total uMARS score (Rho = 0.21; P < 0.017) and subjective quality score (Rho = 0.21; P < 0.017). The vast majority of rheumatic patients would consider recommending Rheuma Auszeit to other patients (117/126; 92.9%).Conclusion: Rheuma Auszeit was well-accepted by German patients suffering from rheumatoid arthritis, psoriatic arthritis and ankylosing spondyloarthritis. Lacking customization could lead to low app compliance and should be improved. Lower functionality scores among older female rheumatic patients highlight the need for patient education. The study underlines the potential and feasibility of therapeutic complementary digital solutions in rheumatology.

Patients with autoimmune chronic inflammatory diseases present increased biomarkers of thromboinflammation and endothelial dysfunction in the absence of flares and cardiovascular comorbidities.

Cardiovascular risk is increased in patients with autoimmune rheumatic diseases. Endothelial, erythrocyte and platelet microvesicles (MVs) are elevated in patients with cardiovascular diseases and represent novel markers of endothelial dysfunction and thromboinflammation. We tested whether their levels are increased in patients with autoimmune rheumatic diseases (ARDs) in the absence of disease flare and cardiovascular comorbidities. Well-controlled patients with rheumatoid arthritis or systemic lupus erythematosus were studied, provided they were free from cardiovascular comorbidities and established cardiovascular disease. We additionally studied (a) a control group consisting of healthy volunteers and (b) a reference group including patients with stable coronary artery disease (CAD). MVs were measured using a standardized flow cytometry protocol. In a population of 74 participants, patients with ARDs (n = 17) presented increased levels of both endothelial (283.3 ± 195.0/μL vs 168.5 ± 54.8/μL, p = 0.029) and platelet MVs (374.0 ± 275.3/μL vs 225.7 ± 101.1/μL, p = 0.046) compared to controls (n = 34), whereas erythrocyte MVs did not significantly differ. In addition, patients with ARDs showed similar levels of endothelial MVs compared to CAD patients (n = 23) (283.3 ± 195.0/μL vs 297.0 ± 211.8/μL, p = 0.846). Platelet MVs were significantly associated with disease duration, and erythrocyte MVs with patients' perceived disease activity. In conclusion, increased levels of endothelial and platelet MVs may be evident in patients with ARDs, even in the absence of disease flares and before the establishment of cardiovascular complications. Levels of endothelial MVs resemble those of patients with profound atherothrombotic profile. The prognostic potential of MVs in terms of cardiovascular disease prevention warrants further investigation in patients with ARDs.

Differences between men and women with nonradiographic axial spondyloarthritis: clinical characteristics and treatment effectiveness in a real-life prospective cohort

BackgroundSex differences with regard to clinical manifestations and response to tumor necrosis factor inhibitors (TNFi) have been delineated for the radiographic form of axial spondyloarthritis (axSpA). More limited evidence for a differential effectiveness of treatment in genders exists for the nonradiographic disease state (nr-axSpA). The aim of the study was to compare demographics, clinical parameters, and response to TNFi in women versus men with nr-axSpA.MethodsWe compared disease characteristics of 264 women and 231 men with nr-axSpA at inclusion in the prospective Swiss Clinical Quality Management Cohort. Response to a first TNFi was assessed in 85 women and 78 men without diagnosed co-morbid fibromyalgia. The primary outcome was the proportion of patients achieving the 40% improvement in the Assessment of SpondyloArthritis international Society criteria (ASAS40) at 1 year. Additional response outcomes were evaluated as secondary outcomes. Patients having discontinued TNFi were considered non-responders. Logistic regression analyses were adjusted for baseline differences, which might potentially mediate the effect of sex on treatment response.ResultsCompared to men, women had a longer diagnostic delay, a higher level of perceived disease activity, and more enthesitis and were in a lower percentage HLA-B27 positive. An ASAS40 response was achieved by 17% of women and 38% of men (OR 0.34; 95% CI 0.12, 0.93; p = 0.02). A significantly lower response rate in women was confirmed in the adjusted analysis (OR 0.19; 95% CI 0.05, 0.62; p = 0.009) as well as for the other outcomes assessed.ConclusionDespite only few sex differences in patient characteristics in nr-axSpA, response rates to TNFi are significantly lower in women than in men.

Patient insights on living with idiopathic inflammatory myopathy and the limitations of disease activity measurement methods \u2013 a qualitative study

BackgroundThe idiopathic inflammatory myopathies (IIMs) are chronic autoimmune conditions, typically resulting in proximal muscle weakness and impacting upon quality of life. Accurate measurement of IIM disease activity is imperative for appropriate medical management and carrying out valid clinical trials. The International Myositis Assessment and Clinical Studies Group (IMACS) “Disease Activity Core Set Measures” are the current gold-standard of IIM disease activity assessment. Anecdotally, patients with an IIM report that the IMACS Core Set Measures and other available methods do not necessarily capture their perceived disease activity. Investigating the patient experiences of living with an IIM and their views on the accuracy of the IMACS Core Set Measures will provide valuable insights for both clinical and research purposes.MethodsEighteen interviews with patients with an IIM were carried out and analysed thematically, using a grounded theory approach. Experiences on living with an IIM and perceptions on the accuracy of disease activity measurement methods were explored.ResultsInterview analysis revealed four themes: 1) fatigue, 2) pain, 3) day-to-day symptom variation, 4) limitations of creatine kinase levels and manual muscle testing.ConclusionsThis study has provided valuable insights into patient experiences of living with an IIM. Aspects of IIM disease activity perceived not to be wholly measured by the IMACS Core Set Measures have also been identified. These findings have implications for future IIM clinical care and research, in particular providing justification for research into pain, fatigue and symptom variation.

PATHOGENESIS OF FIBROMYALGIA IN PATIENTS WITH AUTOIMMUNE DISEASES: SCOPING REVIEW FOR HYPOTHESIS GENERATION

Introduction: Fibromyalgia (FM) prevalence is much higher in patients with other rheumatic diseases than in the general population. This leads to increase in the perceived disease activity scores and prevents patients from reaching remission. Elucidating the pathogenesis of such “secondary” FM can help alleviate some unmet needs in these diseases.&#x0D; Methods: MEDLINE and Scopus databases were searched for a scoping review for hypothesis generation regarding the genesis of secondary FM.&#x0D; Results: FM has been postulated to be due to cytokine dysfunction, neurogenic neuroinflammation, stress, including social defeat, sleep disturbances, sympathetic overactivity, and small fibre neuropathy. These factors increase in most autoimmune and autoinflammatory diseases. Further the evidence for the role of these factors in the pathogenesis of FM is seems strong. Metabolic syndrome and mitochondrial dysfunction are also associated with FM, but it is difficult to distinguish between cause and effect.&#x0D; Conclusion: FM is the common phenotype arising from the amalgamation of various aetiologies. Recruitment or amplification of the above 6 factors by various rheumatic diseases may thus lead precipitation of secondary FM in susceptible individuals.

Development and psychometric validation of a patient-reported outcome measure to assess fears in rheumatoid arthritis and axial spondyloarthritis: the Fear Assessment in Inflammatory Rheumatic diseases (FAIR) questionnaire

ObjectivesTo develop and validate an outcome measure for assessing fears in patients with rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA).MethodsFears were identified in a qualitative study, and reformulated as assertions...

Fatigue in a population-based cohort of patients with inflammatory bowel disease 20 years after diagnosis: The IBSEN study

Objective: Fatigue is a major concern for patients with ulcerative colitis (UC) and Crohn’s disease (CD), but evidence from population-based studies regarding fatigue in long-standing inflammatory bowel disease (IBD) patients is scarce. Our aims were to assess fatigue scores and the prevalence of chronic fatigue in IBD patients 20 years after diagnosis and to identify variables associated with fatigue in this cohort.Methods: Twenty years after diagnosis, patients from a cohort with incident IBD were invited to a follow-up visit that included a structured interview, a clinical examination, laboratory tests and the Fatigue Questionnaire (FQ). Fatigue scores were obtained, and factors associated with fatigue were assessed via linear and logistic regression analyses.Results: Of the 599 invited patients, 440 (73.5%) completed the FQ. Among those with active disease, we found significantly higher fatigue scores than among those with quiescent disease (fatigue scores: UC 17.1 versus 12.4, p < .001, and CD 17.5 versus 13.3, p < .001). The fatigue scores of those with quiescent disease were comparable with those of the reference population. Chronic fatigue was more frequent among IBD patients than in the reference population. Factors associated with fatigue included self-perceived disease activity, poor sleep quality, anxiety and depression.Conclusion: At 20 years after IBD diagnosis, fatigue scores were higher and chronic fatigue was more frequent among IBD patients with active disease than in the reference population and among those with quiescent IBD. Subjectively perceived disease activity, sleep quality, anxiety and depression were associated with fatigue in IBD patients.

Beneficial Effects of Education on Emotional Distress, Self-Management, and Coping in Patients with Inflammatory Bowel Disease: A Prospective Randomized Controlled Study

Background: Patients with inflammatory bowel disease (IBD) suffer from various physical as well as psychological impairments, and patient education may help improve their well-being. Therefore, we developed a manualized education program for IBD patients addressing medical and psychological issues. This study aimed to evaluate it in a large controlled trial. Methods: A total of 181 IBD outpatients participated in a prospective, randomized, waitlist-controlled trial; assessments were made before as well as 2 weeks and 3 months after intervention. Analysis of covariance was used to assess intervention effects on disease-related worries and concerns (primary outcome), fear of progression, coping with anxiety, health competencies, health-related quality of life (HRQoL), perceived disease activity, symptoms of depression and anxiety, disease-related knowledge, and coping strategies. Participants' satisfaction with the program was also evaluated. Results: At 2 weeks and 3 months after intervention, we found significant large effects of our education program on skill and technique acquisition, knowledge, and coping with IBD. Moreover, we found significant medium effects on disease-related worries and concerns, fear of progression, coping with anxiety, constructive attitudes and approaches, as well as coping with disease-related negative emotions. The number of coping strategies used was significantly higher at 3 months. We did not find any effects on perceived disease activity, HRQoL, positive and active engagement in life, or symptoms of anxiety and depression. The program was rated very favorably by the attendees. Conclusion: Our education program contributed to improvements in psychological distress, self-management skills, and coping and was appreciated by its attendees.

PWE-097 Patient Knowledge Of Inflammatory Bowel Disease Is No Better Than In 1999

IntroductionIn the UK, key professional organisations have collaborated to provide inflammatory bowel disease (IBD) Standards to be delivered by the NHS, highlighting the importance of patient education and support.1 Little...

Effect of Cardiovascular Training on Fitness and Perceived Disease Activity in People With Ankylosing Spondylitis

Several studies suggest that patients with ankylosing spondylitis (AS) have an increased risk of cardiovascular disease. This study aimed to evaluate the effects of a 12-week, individually monitored, with moderate heart rate level intensity cardiovascular training on cardiovascular fitness and perceived disease activity in AS patients. Patients diagnosed with AS according to the modified New York criteria were randomized to either cardiovascular training or attention control. The training group performed 3 cardiovascular training units per week. All participants attended 1 weekly usual care flexibility training session. Attention control contained regular discussion groups on coping strategies. Adherence was self-monitored. Assessments were performed at baseline and after the intervention period of 3 months. Physical fitness was the primary end point, measured in watts using a submaximal bicycle test following the physical work capacity 75% protocol. All analyses controlled for sex, age, body mass index,baseline fitness and physical activity levels, and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Of 106 AS patients enrolled, 40% were women and the mean ± SD age was 49 ± 12 years. A total of 74.6% of the training group reported exercising at least 3 times a week. At the 3-month followup, the fitness level in the training group was significantly higher than in the control group (mean ± SE 90.32W ± 4.52W versus 109.84W ± 4.72W; P = 0.001), independent of other covariates. The mean BASDAI total score was 0.31 points lower (P = 0.31) in the training group, reaching significance for the peripheral pain subscore (1.19; P = 0.01) but not for back pain or fatigue. Cardiovascular training, in addition to flexibility exercise, increased fitness in AS patients and reduced their peripheral pain.

THU0260 Circulating levels of tnf-like cytokine 1A (TL1A) are increased in patients with ankylosing spondylitis

BackgroundTL1A (TNFSF15) is a newly identified TNF-like cytokine that associates with the death domain receptor DR3 (TNFRSF25), expressed on activated lymphocytes. TL1A-DR3 binding produces costimulatory signals resulting in lymphocyte proliferation,...

ON001 An investigation of the manifestations of perceived psychological stress in patients with inflammatory bowel disease

Background: Inflammatory Bowel Disease (IBD) is a chronic, inflammatory condition of the gastrointestinal tract and is a term used to describe Crohn’s Disease and Ulcerative Colitis. Studies to date suggest that psychological stress is associated with increased levels of disease activity. There is a dearth of literature on the relationship between psychological stress and its impact on clinically measured disease activity. The aim of this study is to investigate the effects of perceived stress on disease activity in patients with Inflammatory Bowel Disease and to explore if a relationship exists between perceived stress and perceived or clinically measured disease activity. Methods: A quantitative, correlational, descriptive design with a convenience sample of 100 patients was used. Data were collected, using the Perceived Stress Scale Questionnaire and the Harvey Bradshaw Disease Activity Index. Descriptive and inferential statistical analyses were used to answer the research questions. Results: Perception of current disease activity illustrated that (n = 24) 24% felt their disease was in remission while (N = 21) 21% felt it was severe. Significantly (n = 74) 74% experienced abdominal pain. The majority (n = 62) 62% of respondents felt nervous and stressed fairly or very often (P= 0.610). More than half of respondents, (N = 53) 53% had a C-Reactive Protein (CRP) of <1. A statistically significant correlation was found between perceived stress and perceived disease activity (P= 0.653). However there was no correlation found between perceived stress and actual disease activity as measured by CRP. There was no correlation found between perceived disease activity and actual disease activity as measured by CRP. Conclusions: Respondents with high perceived stress scores reported higher levels of perceived disease activity. The Clinical Nurse Specialist is the primary point of contact for all IBD patients and as such requires a very clear understanding of the psychological manifestations of stress and its relationship with disease activity. ON002 Simple question, simple answer, complex implications: What does a distress thermometer tell us about disease activity and quality of life in IBD patients? D. Keegan1 *, K. Byrne1, E. McDermott1, N. Rafter1, G. Cullen1, G. Doherty1, H. Mulcahy1. 1St Vincent’s University Hospital, Centre for Colorectal Disease, Dublin, Ireland

The Interaction of Physical Function and Emotional Well-being in Rheumatoid Arthritis—What is the Impact on Disease Activity and Coping?

To evaluate the impact of the interaction of physical function and emotional well-being on disease-related parameters and coping with rheumatoid arthritis. A cross-sectional survey among 177 RA patients included demographic and disease-related variables as well as the following patient-reported outcome measures: Health Assessment Questionnaire-Disability Index (HAQ-DI) (physical function), Mental Component Summary Scale of the SF-36 (MCSS) for emotional well-being, Rheumatoid Arthritis Disease Activity Index (RADAI), and Coping with Rheumatoid Arthritis Questionnaire (C-RAQ). Based on HAQ-DI and MCSS, six categories representing various levels of physical and emotional impairment were formed. Multivariate analysis of variance and a subsequent discriminant analysis were used to evaluate whether demographic and disease-related variables and coping strategies differed between these categories. Patients with moderate to high impairment of physical function and emotional well-being reported significantly higher disease activity and a more frequent use of distancing and active problem solving coping strategies than patients with low-level impairment (p<0.001-0.043). Furthermore, these patients reported experiencing significantly higher levels of helplessness (p<0.001-0.032). Results from the discriminant analysis highlighted a combination of disease activity and helplessness to differentiate best between patients with either low or high impairment of physical function and emotional well-being (p<0.001). Aside from perceived disease activity, helplessness, and distancing as well as active problem solving allowed for a good discrimination between the different levels of impairment of physical function and emotional well-being. Encouraging and educating patients on how to cognitively reframe their current situation might play a key role in reducing the level of helplessness resulting from impairments of physical function and emotional well-being.

Cardiovascular training improves fitness in patients with ankylosing spondylitis

Objective: Several studies suggest that patients with ankylosing spondylitis (AS) have an increased risk of cardiovascular disease. This study aimed to evaluate the effects of a 12-week individually heart rate-monitored, moderately intensive cardiovascular training on cardiovascular fitness and perceived disease activity in AS patients. Methods: Patients diagnosed with AS according to modified New York criteria were to either 'cardiovascular training' or 'attention control'. The training group performed three cardiovascular trainings per week. All participants attended one weekly usual care flexibility training. Attention control contained regular discussion groups on coping strategies. Adherence was self-monitored. Assessments were performed at baseline and after the intervention period of 3 months. Physical fitness was the primary endpoint, measured in watts using a submaximal bicycle test following the PWC75% protocol. All analyses controlled for gender, age, body mass index, baseline fitness and physical activity levels, and BASDAI. Results: Of 106 AS patients enrolled, 40% were women, mean age was 49 (SD +/-12) years. 76.5% of the training group reported exercising at least three times a week. At 3 month follow-up, fitness level in the training group was significantly higher than in the control group (90.32 (SD 4.52) vs.109.84 (SD 4.72) respectively, p=0.001), independent of other covariates. Average BASDAI total score was 0.31 points lower (p = 0.31) in the training group, reaching significance for the 'peripheral pain' subscore (1.19; p=0.01), but not for 'back pain' or 'fatigue'. Conclusions: Cardiovascular training, in addition to flexibility exercise, increased fitness in AS patients and reduced their peripheral pain.

Increased levels of soluble TNF-like cytokine 1A in ankylosing spondylitis

To determine the expression of soluble TNF-like cytokine 1A (sTL1A), a new member of the TNF superfamily, in patients with AS. Seventy-five consecutive patients with AS [61 males, mean (S.D.) age: 47.2 (15.5) years, disease duration: 20.3 (13.9) years] were included in this study. Forty-four patients were anti-TNF treatment naïve, whereas the remaining patients were on infliximab (n = 21), adalimumab (n = 3) or etanercept (n = 7). The patients' perceived disease activity was recorded by BASDAI and AS DAS using serum CRP levels (ASDAS-CRP), whereas functional status was assessed by BASFI and measurements of spinal mobility (AS Metrology). Serum concentrations of TL1A were measured by ELISA. Twenty-five age- and sex-matched healthy individuals served as controls. Anti-TNF treatment-naïve patients demonstrated a 2.6-fold higher sTL1A average value [mean (s.e.m.) 581 (157.5) pg/ml] compared with healthy controls [226.7 (48.24) pg/ml, P = 0.042]. The sTL1A levels of anti-TNF-treated patients [178 (42)] were significantly lower than anti-TNF treatment-naïve patients (3.3-fold decrease, P = 0.0038) and comparable to those of healthy controls. No significant association was found between sTL1A level and functional status (BASFI score, AS Metrology parameters) or CRP measured in the same sera; however, a positive correlation was observed between individual levels of sTL1A and both BASDAI (P = 0.008) and ASDAS-CRP (P = 0.058) scores suggesting that sTL1A levels may reflect disease activity in patients with AS. TL1A is up-regulated in AS, associates with disease activity and is influenced by anti-TNF treatment, suggesting that TL1A may be of pathogenic and potentially of therapeutic importance in AS patients.

Differences in the health-related quality of life, affective status, and personality between irritable bowel syndrome and inflammatory bowel disease patients

To investigate differences in the health-related quality of life (HRQoL), number of stressful life events, affective status, and some personality characteristics between patients with inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) as well as their possible role in disease activity. Fifty-six IBS outpatients, age range 25-75 years (mean = 48.64; SD = 13.04) and 43 outpatients with IBD, age range 19-74 years (mean = 42.90; SD = 15.44), participated in this study. Patients filled out the following questionnaires: Short-Form 36 Health Survey, Beck Depression Inventory, Spielberger's Trait-Anxiety Inventory, Big Five Inventory, and Stressful Life Events Questionnaire. There were significant differences in the physical component (F = 10.80, P<0.001) of the general HRQoL as well as in anxiety (F = 7.23, P<0.01) and neuroticism (F = 8.90, P<0.01) between patients with IBS and IBD. IBS patients showed a significantly higher level of anxiety and neuroticism and better physical aspects of general HRQoL compared with IBD patients. The results of standard regression analyses indicated that a significant predictor (beta = -0.44, P<0.01) for the perceived disease activity in IBS was neuroticism as a personality trait. The results of this study show that the patients with IBS are more prone to the effect of psychosocial variables on gastrointestinal symptoms compared with patients with organic gastrointestinal diseases such as IBD. IBS patients experienced a higher level of anxiety and expressed a higher level of neuroticism as a personality trait compared with IBD patients.

Total and free insulin-like growth factor I, insulin-like growth factor binding protein 3 and acid-labile subunit reflect clinical activity in acromegaly

The aim was to evaluate, markers of disease activity in acromegaly in relation to perceived disease activity. Thirty-seven consecutively treated, acromegalic patients, classified by clinical symptoms as inactive (n=16), slightly active (n=10) and active (n=11), entered the study. When evaluating the inactive and the active groups, we found that positive and negative predictive values (PV(pos), PV(neg)) for clinical disease activity of total and free insulin-like growth factor-I (IGF-I) were 0.59, 0.90 and 1.00, 0.82 respectively. Acid-labile subunit (ALS) showed diagnostic merit similar to insulin-like growth factor binding protein-3 (IGFBP-3) with PV(pos) of 0.69 and 0.71 and PV(neg) of 0.91 and 0.92 respectively. We conclude that free IGF-I is more closely related than total IGF-I to perceived disease activity and is as such useful when evaluating previously treated acromegaly for disease activity. Total IGF-I, IGFBP-3 and ALS possess a higher PV(neg) for the clinical disease activity. None of the parameters can at present be claimed to be superior to the others and thus all the measured parameters are recommended to be part of the evaluation of acromegalic patients.

Effects of Static and Dynamic Shoulder Rotator Exercises in Women with Rheumatoid Arthritis: A randomised comparison of impairment, disability, handicap, and health.

The aim was to compare static and dynamic shoulder rotator endurance training in a group of women with mild rheumatoid arthritis and to see whether such training could influence impairment, disability, and handicap. The effects on general health were also studied. Patients were randomly assigned to a static (n =17) (average age 59, median disease duration 7) or a dynamic training group (n =20) (average age 56, median disease duration 10.5). Measurements were taken at the start, 10 weeks later when the training period was finished, and after a further 10 weeks. After the training both groups had fewer swollen joints in the upper extremity and less shoulder-arm pain. The dynamic group patients also improved according to the physical and overall dimensions of the Sickness Impact Profile. As impairment and aspects of disability and handicap were influenced by training but not by the patients' opinions regarding perceived disease activity and health, these relationships must be studied further.

Rheumatoid arthritis patients cannot accurately report signs of inflammatory activity.

If patients with rheumatoid arthritis (RA) could self-report symptoms in a manner which correlated with laboratory measures of inflammation this would be a valuable research or clinical tool. Developing such a tool means ensuring that the questions are understood and a variety of combinations of signs, symptoms and joints explored. Preliminary studies in two groups of 20 RA out-patients established an acceptable self-report questionnaire format by which patients could identify their joints. Fifty RA out-patients completed these self-report forms on four grades of each of four symptoms (pain, heat, stiffness, swelling) in each of 64 joints, as well as visual analogue scales (VAS) on overall pain and perceived disease activity. A clinical research assistant recorded the Thompson-Kirwan articular index (TKAI) and plasma viscosity (PV) was measured. The data were analysed in a variety of ways in an attempt to construct a self-report articular index (SRAI) which correlated with PV. The strongest models were then tested in 11 in-patients undergoing a flare of their disease. No adequate SRAI could be constructed which correlated with PV and in addition neither VAS score correlated with PV. There was a moderate correlation between the TKAI and a patient SRAI using the same joints, symptoms and weightings (r = 0.6, P < 0.01). Patients can clearly report different grades of multiple symptoms in multiple joints, but such reports cannot be shown to be a reliable indicator of inflammatory activity.