RHEUMDOC: a one-page RHEUMatology DOCtor form with four physician global estimates for overall status, inflammation, damage, and symptoms based on neither inflammation nor damage.

A physician estimate of global status (DOCGL) is among the seven core data set measures to assess patients with rheumatoid arthritis (RA) and included in many rheumatic disease indices. In clinical trials designed to reduce in flammation, DOCGL is directed to estimate inflammatory activity. However, patients with inflammatory rheumatic diseases also may be affected by organ damage (e.g., to joints in RA, kidneys in SLE, muscles in polymyositis, and so forth.). Furthermore, fibromyalgia has been reported in 20% to 40% of patients with RA and other inflammatory rheumatic diseases, which may complicate their management. We sought to clarify a global summary of patient status by supplementing DOCGL with three additinal separate (0-10) physician global estimates for inflammation (DOCINF), damage (DOCDAM), and neither inflammation nor damage (DOCNON) (often fibromyalgia, but may be other chronic pain or somatization syndromes). In analyses of new patients with six diagnoses, mean overall DOCGL scores were highest for patients with fibromyalgia, followed by RA, spondyloarthropathy, osteoarthritis, gout, and systemic lupus erythematosus. Among the three subscales, mean DOCINF scores were highest in RA, spondyloar- thropathy, gout, and systemic lupus erythematosus; mean DOCDAM highest in osteoarthritis; and mean DOCNON in fibromyalgia. In patients with RA, mean DOCDAM and DOCNON scores indicated coexistence of clinically impor tant damage or fibromyalgia in some patients. These data indicate face validity of the three physician global estimates on subscales for inflammation, damage, and symptoms due to neither inflammation nor damage. These estimates reflect the expertise of the rheumatologist and may be helpful to interpret rheumatic disease indices.