Pincus T, Brooks R H, Callahan L F
Vanderbilt University School of Medicine, Department of Medicine, Nashville, TN 37232-4500, USA.
J Rheumatol. 1999 Feb;26(2):473-80.
A proposed 4 page, 30-45 minute standard protocol to assess rheumatoid arthritis (SPERA) is described that includes all relevant measures of inflammatory activity such as joint swelling, measures of joint damage such as joint deformity, and outcomes such as joint replacement surgery, to monitor patients in longterm observational studies. Forms are included: (1) a patient self-report modified health assessment questionnaire (MHAQ) to assess function, pain, fatigue, psychological distress, symptoms, and drugs used; (2) assessor-completed forms: "RA clinical features" --criteria for RA, functional class, family history, extraarticular disease, comorbidities, joint surgery, radiographic score, and laboratory findings. (3) A 32 joint count with 5 variables: (a) a "shorthand" normal/abnormal so that normal joints require no further detailed assessment; (b) tenderness or pain on motion; (c) swelling; (d) limited motion or deformity; (e) previous surgeries; physical measures of function, i.e., grip strength, walk time, and button test. (4) Medication review of previous disease modifying antirheumatic drugs (DMARD), work history, and years of education. The forms allow cost effective acquisition of all relevant measures of activity, damage, and outcomes in routine clinical care, and allow recognition that measures of activity may show similar or improved values over 5-10 years, while measures of damage and outcomes indicate severe progression in the same patients. The SPERA is feasible to acquire most known relevant measures of activity, damage, and outcomes in RA in 30-45 min in usual clinical settings, to provide a complete database for analyses of longterm outcomes.
本文描述了一种拟议的4页、30 - 45分钟的评估类风湿性关节炎的标准方案（SPERA），该方案包括炎症活动的所有相关测量指标，如关节肿胀；关节损伤的测量指标，如关节畸形；以及关节置换手术等结局指标，用于长期观察性研究中对患者进行监测。方案包含以下表格：（1）一份患者自我报告的改良健康评估问卷（MHAQ），用于评估功能、疼痛、疲劳、心理困扰、症状及所用药物；（2）评估者填写的表格：“类风湿性关节炎临床特征”——类风湿性关节炎的标准、功能分级、家族病史、关节外疾病、合并症、关节手术、放射学评分及实验室检查结果。（3）一份包含5个变量的32关节计数：（a）一种“简写”的正常/异常情况，正常关节无需进一步详细评估；（b）活动时压痛或疼痛；（c）肿胀；（d）活动受限或畸形；（e）既往手术；功能的体格测量指标，即握力、步行时间及纽扣试验。（4）既往改善病情抗风湿药物（DMARD）用药回顾、工作经历及受教育年限。这些表格能在常规临床护理中经济高效地获取活动、损伤及结局的所有相关测量指标，并且能认识到活动测量指标在5 - 10年期间可能显示相似或改善的值，而损伤和结局测量指标则表明同一患者病情严重进展。在通常临床环境中，SPERA在30 - 45分钟内获取类风湿性关节炎活动、损伤及结局的最知名相关测量指标是可行的，可为长期结局分析提供完整数据库。
