Description

Symmons et al developed a simple measure for the overall status in rheumatoid arthritis (OSRA). This can be used to monitor patients in routine clinical practice. The authors are from the University of Manchester, Keele University, Manchester Royal Infirmary, and Royal Hospital Buxton in England.


 

Patient selection: rheumatoid arthritis

 

Parameters:

(1) disease duration in years

(2) well-being

(3) joint point

(4) early morning stiffness (EMS) in minutes

(5) active joint count

(6) extra-articular disease

(7) functional impairment

(8) social life

(9) number of destroyed or replaced large joints

(10) small joint damage

(11) organ impairment (6.01 to 12 months)

(12) drug therapy

 

Parameter

Finding

Code

disease duration

< 10 years

A

 

10 to 20 years

B

 

> 20

C

drug therapy

none or analgesics

A

 

NSAIDS only

B

 

second line

C

 

second-line plus steroid

D

 

cytotoxic with or without steroids

E

 

steroids

F

 

biologics

G

 

 

Parameter

Finding

Points

well-being

better

0

 

same

0

 

worse

1

 

much worse

2

joint pain

none

0

 

mild

0

 

moderate

1

 

severe

2

early-morning stiffness

< 30 minutes

0

 

30 to 60 minutes

1

 

> 60 minutes

2

active joint count

< 3

0

 

3 to 10

1

 

> 10

2

extra-articular disease

none

0

 

new nodules

1

 

vasculitis, serositis, other

2

functional impairment

mild

0

 

problems with ADL (dressing, eating, climbing stairs)

1

 

housebound

2

social life

normal

0

 

moderately impaired

1

 

severely impaired

2

large joints destroyed or replaced

0

0

 

1 or 2

1

 

>= 3

2

small joint damage

mild

0

 

needs collar, special shoes, hand splint, etc

1

 

surgery

2

organ impairment

none

0

 

mild

0

 

skin or muscle

1

 

major organ(s)

2

 

subscore for activity =

= SUM(points for items 2 through 6)

 

subscore for damage or impact =

= SUM(points for items 7 through 11)

 

Interpretatation:

• minimum activity and damage subscores: 0

• maximum activity and damage subscores: 10

• The higher the subscores the more severe the RA.

 

Performance:

• The OSRA was validated in Symmons et al with demonstration of face validity, content validity, construct validity, criterion validity, and discriminant validity.


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