In 2011, Pfizer sent a Dear Doctor letter warning that its Rheumatology Calculator app was generating mistakenly high and low scores for measuring tender and swollen joints in patients with arthritis, sometimes by as much as 50% [PDF].
It is scored by simply adding the numerical values corresponding to the following set of predetermined elements: the 28 joint assessment used to measure tender and swollen joint count; patient and physician global assessment of disease activity measured using a visual analogue scale, and finally, levels of the measured C-reactive protein (mgudl, normal <1 mgudl) [ 8].
The following indices were measured: tender joint count, swollen joint count, patient's assessment of pain, patient's global assessment of disease activity, physician's global assessment of disease activity, the Disability Index of the Health Assessment Questionnaire, serum levels of C-reactive protein and erythrocyte sedimentation rate.
The Boolean definitions with the highest LRs (2.6) for good outcomes were those that had at least five measures - tender joint count (TJC), swollen joint count (SJC), C-reactive protein (CRP), patient global assessment, and physician global assessment or patient pain - while the ACR/EULAR-recommended four-item remission definition performed very similarly (LR = 2.4).
Tocilizumab treatment significantly improved all measures, including tender joint counts, swollen joint counts (fig 3B), CRP levels (fig 3C), MHAQ score (fig 3D) and DAS28 score (fig 3E), and the efficacy was sustained throughout the 5-year treatment.
The announcement comes after years of negotiations and saw the Madrid regional government announce what appeared to be a made-to-measure public tender.
Diffuse hyperalgesia, as measured by tender points, contributed in explaining the back pain.
The former, we measured using tender, swollen and painful joint counts, the latter, using the deformed joint count.
The Wilcoxon signed rank test was used to assess the statistical significance of changes in the subjective efficacy measures (VAS scores), tender points, tender joints, ESR, CRP, B cells, T cells, and Igs, compared with their baseline values.
In addition, the patients with RA were comprehensively evaluated for disease activity with the use of the following measures: 1. Tender and swollen joint count (maximum of 68 tender and 66 swollen joints).
