The HAQ’s, the RAPID’s & the Rest: 3 Reasons It’s a Moot Point
So often when I’m listening to a scientific presentation about clinical care for Rheumatoid Arthritis, I would do the face-palm head-smack, if my shoulder would let me. Depending on who can hear me, I mutter softly or wail sarcastically, “If it’s not done, does this matter?” One example is measuring RA disease activity, especially with “Patient Outcome Measures,” which has always been a key topic on RA Warrior.
Bottom line – that’s right – at the top of the post. But, please keep reading.
- The various HAQ’s are mediocre tools used to gauge the effects of RA.
- The RAPID3 is superior, partly because it’s more feasible, increasing odds of its being used.
- If none of these measures are used in most cases, the debate is pointless.
When there are debates about patient outcome measures of Rheumatoid Arthritis, they are about which test is more consistent or accurate, not about whether they should be used. There are plenty of nit-picky technical articles about how to best compare and interpret various versions of the HAQ and other outcome measures, including this explicit discussion of clinical use and interpretation of RAPID tests.
But the question of its value seems to be settled: “A careful history and physical examination, including a nonquantitative joint examination, form the foundation of any encounter of a physician and patient with RA,” Journal of Rheumatology, Vol. 5, no. 11. In a fundamental discussion about assessing RA patients in 2009, RAPID3—An Index of Physical Function, Pain, and Global Status as “Vital Signs” to Improve Care for People with Chronic Rheumatic Diseases, Pincus wrote, “It is suggested that all rheumatologists would find it valuable to ask all patients to complete a MDHAQ and to score a RAPID3 at all visits of all patients in usual care.”
We’ve heard some of the top rheumatologists in the world start a conversation with, “We all do the HAQ and joint counts, but we know it’s not enough…” We do? My brother always used to ask me, “We? You got a mouse in your pocket?” It’s an 80’s saying that means, “You, and who else?” Do they assume all rheumatologists are measuring as they do?
Can we talk more about that mouse next time?
Pincus and Segurado reported in 2006 that “Most visits of most patients with rheumatoid arthritis to most rheumatologists do not include a formal quantitative joint count.” It’s not done either. It seems little measuring is done period, from the patients we’ve heard from so far.
If you are a rheumatology patient, how often does your rheumatologist count your joints or give you a RAPID or a HAQ to fill out?
If you are a care provider, how do you typically measure?
Postblog: We’ll continue to discuss measuring RA here. Whether you’re a care provider or a patient, I recommend the articles and PDF’s provided on this page by Pincus et. al.: “RAPID3 (Routine Assessment of Patient Index Data 3), a Rheumatoid Arthritis Index Without Formal Joint Counts for Routine Care: Proposed Severity Categories Compared to Disease Activity Score and Clinical Disease Activity Index Categories.” Some of these have been quoted on this site before, but this is a great list.
I realize the patients and doctors who read this blog are better educated and more involved and so may be more likely to be measuring, but let’s see what folks say over the next few weeks.
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Edit: 9 am EST: Just saw this coupon in the email good today only for the RA Warrior t-shirt store. Too late to add it to the RSS feed but here it is!
The full scoop…
Cyber Monday Sale
Coupon Code: CyberMon11
Discount: 40% off all orders over $50
Dates: Today only, Monday November 28th
Disclaimer: Please enter coupon code CyberMon11 before completing checkout. Discount is applied to the base price and does not include commissions, taxes or additional charges. Email us if you have questions or need help calculating the discount for customers. This offer may not be combined with other offers. If word spreads like wildfire it’s possible some orders may delayed just a bit. Coupons valid from 11/28/2011 to 11/28/2011 11:59 pm Mountain Time.Recommended reading
- Winter Solstice Lunar Eclipse: Was the Moon Really Red?
- Measuring Rheumatoid Arthritis Disease Activity
- Weight of Patient Reported Outcome Measures on Diagnosis & Treatment of RA
- The Value of Patient Reported Outcome Measures of Rheumatoid Arthritis
- A Paradigm Shift in Rheumatoid Arthritis Disease Activity? Part 3
Kelly Thank you for bringing this subject up. I can honestly say my Rheum Doc does not do a joint count because he really does not do an exam. I never had disrobed. He bends my knees with my jeans on and he bends my elbows with my sweater on. He pokes at my wrists on occasion and my fingers. The ONLY function/pain assesment he does is four questions
1. Any change in your abilites to work or occupation
2. Any change in your abilities of daily living eating or dressing (oh please I think, I expect more than just being able to do that!)
3. Any change in your ability to do HOUSEWORK or HOUSEHOLD CHORES (Oh please my husband has been helping me for years, I want to be able to walk, exercise, isn’t that what you tell me I should be doing?)
Then he does put a pain scale on the bottom of the page stating: How much pain have you had doe to your illness in the past week…and you mark it with an X
Compared to what I have heard other RA patients have for an exam and assesment of functioning…MY Rheum Doc’s is pathetic to say the least. I would leave him and find another if there was one in my area I could go to…I live in Rural Maine. Something HAS to change. Rheum Docs are getting away with this. They see many patients and maybe one might say this is due to a lack of Rheum Docs? But I personally think there is no excuse for this type of inadequate Rheum Care…Thanks again Kelly for bringing this topic up…We have to start shaking things up…and the first step is to expose the truth of how RA care really inadequate and the standards of care vary markedly….all over the country…
Hi Susan, Haven’t been well enough to read current responses to Kelly’s blog. I too live in rural Maine and frustrated over the lack of rheumatologists to pick from in this state. It takes me an hour to the one I go to now in Portland. Another specialist I use now is in New Hampshire (I live near the border) and I travel 1 1/2 hours to see him. I just moved here 7 years ago and find the healthcare system up here very frustrating. I worked as a nurse for over 30 years before becoming disabled 5 years ago.
I have been thinking about starting a chronic pain support group in my area as the only one I can find that is for all painful conditions is again an hour’s drive.
Best wishes to you and hope you are feeling well during this holiday season.
Marianne
I would like to say that in non-rural areas this is the standard practice but I would be lieing. I travel to Charlotte, NC, which is a fairly big city to see my rheumy. I read your post and said, hmmmmm. I don’t know what these things are, that Kelly is talking about in this article.
I do a lot of talking at my appointments. Like Susan’s doctor, mine flexes my knees (in clothes) my arms to check shoulder movement, and then tortures my hands. I’m sure she’s doing something productive with the hands…but I basically zone out and try to get through the pain.
I do not know what the RAPID or the HAQ are, and I’m going to read up on them so we can have a chat when I go in next.
I am perfectly capable of demanding my doctor do a better job. Luckily for me, she listens, and my talking to her may make a difference. Being in a big city does have its advantages, if I don’t feel she’s rising to the challenge, I can look elsewhere.
But “we” certainly does not include my rheumy. Thank you for helping me help myself.
I just love this blog.
~Jennifer
He first few times I went to the rheum, she touched and moved every joint. Now she goes touches all joints that have been inflamed in the past and asks if there are any new spots. So, she does hands, feet, wrist, ankles, shoukders ans SI joint. I have filled out a questionnaire once (dx for ten months).
I think mine does a great job–hard to fib about no pain when she’s manipulating!
Maybe it is because I live near a large city ( Jacksonville, FL) , but my doc always examines my joints. I don’t think he has ever actually counted but he does ask about changes in pain and function at every visit and checks any I say have changed for good or bad. He is also very careful when moving joints so he does not cause more pain than necessary. After reading so many posts about bad rheumatologists on this site I feel very lucky. Though I have had my run ins with other specialties and other rheum docs that are very bad, it has taken 20 years and a new location to get a correct diagnosis.
I think your own “statistics” over 20 years tell the story, China. It can take a long time to get a diagnosis and care. And then to find someone who uses “modern” methods in this changing field.
The other thing that is shown by your comment is how important it is to not give up – since there are good drs to be found – like the one you have now. We want patients to find that sooner than 20 years if possible because of the damage that RA can do in many people in the meantime.
When you check in at my doc, you are given a clipboard with a questionaire. It asks about problems you have had since your last visit as an open question. It then asks for a pain score and a HAQ type score from 0 to 100 about your overall impression of your health. There is also a preventive health form I fill out a couple times a year about vaccinations, pap smear, weight goals,etc. My rheumy does a joint exam every time, on almost every joint. She also has me do certain movements for her and asks about my ability to do tasks at work and whether I am feeling well enough to go to yoga classes, etc, which she knows are important to me. Towards the end we talk about side effects, etc, and make any med changes if needed. This is totally different from my last four rheumy’s, two of which had NO forms ever, even for first visit.
Thanks, Leslie. So, you’ve seen 5 total – High five for persistance to find a good one. I think the HAQ or the DAS or any of these are calculated based on the joint counts or your answers on the forms – there are quick ones like the rapid or calculators to help the docs w/these forms – but filling out the forms has to be the first issue – actually asking the patients the questions.
The preventatives form also gives your doc special place here! This is one of the most important things he can do to improve and extend your life – we have a tag here about preventive health with RA since its so important – yours is the first RA doc I’ve seen who does that. Wonderful. So important to include eye and cardiac monitoring and send you for a DEXA to ck bone density…
My rheumatologist is wonderful. Every appointment she examines my joints, notes my swelling & always checks my range of motion. She usually anticipates my questions at each appointment. I have the feeling that she really sees and hears what her patients say to her and so has confidence, knowledge & expertise in dealing with the disease, meds, side effects, pain, ect. I haven’t heard of the diagnostic tools you mentioned in your blog but I’m ok with that because my doctor is excellent & really feel like she understands my disease.
Ruby, that’s great you have such a caring doc. My first rheum was like that so much I never wanted to leave – it was so hard and scary to leave back in 2009. I finally had to because I wasn’t getting any better and I wanted to know if there was a dr who knew more about controlling RA or helping me do more since I keep losing more ability & have constant pain. The tools mentioned are for measuring your disease so it can show whether the RA is progressing or whether the meds are working – although I think I’d know if they had too. 🙂
I am happy that you have someone you are so confident in – I wish that for all of us.
Just saw this coupon in the email good today only for the RA Warrior t-shirt store. Too late to add it to the RSS feed but here it is!
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Disclaimer: Please enter coupon code CyberMon11 before completing checkout. Discount is applied to the base price and does not include commissions, taxes or additional charges. Email us if you have questions or need help calculating the discount for customers. This offer may not be combined with other offers. If word spreads like wildfire it’s possible some orders may delayed just a bit. Coupons valid from 11/28/2011 to 11/28/2011 11:59 pm Mountain Time.
Kelly, as usual you have enlightened us. Thanks! My rheumy does a pretty good job. Each visit I have to fill out a form on what I can and can’t do and how much difficulty I have performing task on a scale of 1-10. The form also includes an area for pain with a scale. On a seperate form I have to go over all of my medications, vitamins, supplements and make any changes. She really digs into my joints, at least that is how it feels. It does hurt, but I am pretty sure it can’t be avoided. The only area that I think she is too quick with are my feet. Since reading this, I am going to ask her (tactfully I hope) about that.
Sounds like she examines the joints for inflammation – that digging / squezzing you feel. It’s one way in addition to asking you – that she can get a joint count. She may be counting them without telling you so you could ask about that or better yet, read over a copy of her notes so you know what she does with that. The form each visit is a very good sign too. Thanks for posting this good example for others to see!
My situation is a little different than most with RA, I suppose. I have an artificial elbow joint from an accident pre-RA. It greatly affects my functioning and day-to-day activities so I’m always at a loss when asked how my daily functioning is. I do my best to estimate based on the limited function I had after the arm repair, but really, how do I know which is the disease and which is the aftermath?
At my last appointment with my rheumy, she had me fill out a questionnaire. This is the first time she’s ever done that. She has told me specifically that she doesn’t use the computer at all to keep up with the latest info so maybe word is getting into the med journals as well? Is it okay to print some of your blog posts to share with her and (hopefully) entice her to begin becoming more tech-savvy?
My first Rheum doc, no joint count, no forms, he would check a joint if I mentioned it. Really he just wanted to give more meds and get me out of there. I have only seen my new doctor once back in August. I go to the VA and I lost my free care because of income from a part time job I took in 2010. Since this year is the worst yet income wise, I will be back on it after the first of Jan. and will see him then. I did notice that the new doctor wasn’t a Rheum but was in Internal Medicine. Hmmm. The only thing they do is the nurse asks you what your pain level is when you first get there.
I would appreciate it if they would add level of fatigue starting with I feel a little sleepy on up to I can’t keep my eyes open!!! Seriously by 2 in the afternoon, I am exhausted, feeling nauseated. If I don’t take a 2 to 3 hour nap, I am weepy by 8. Me, who had a friend ask once if I ever get emotional, do I ever cry?? I cry at the drop of a hat now, I’m a big weepy, cry baby and I hate it!
I have never been given ANYTHING to fill out at my rheumatologist’s office, other than insurance forms. Gotta make sure they get their money, ya know. THAT’S what’s most important…. at least to them.
He has never counted any joints, either. My visits are less than 3 minutes long, and questions are neither asked for nor welcomed. Basically, I get my vitals done, he pinches my hand and my feet, and asks if my medication is working. The last time I told him no, he suggested taking me off of it and told me “Well, you don’t have THAT bad of a case. Maybe try some ibuprofen. It has anti-inflamatory qualities.” Then he walked out the door.
I’m wondering whether he’s just a terrible doctor, or if he treats all of his Medicaid patients that way. I’ve grown accustomed to being brushed aside and treated like an idiot by pretty much ALL doctors since I’ve had to stop working (due to my RA) and been forced to go on Medicaid. I wonder how he would treat me if I had my Blue Cross/Blue Shield back. But since he won’t treat me, I won’t be able to go back to work, and I’ll never know. Regardless, it has been 8 months since I’ve seen him and I’m on the hunt for a rheumatologist who accepts Medicaid and actually WANTS to TREAT me, not just brush me off.
Dear Lisa,
I’ve never filled out forms like that either. And I’ve now seen several rheumatologists – only 1 of whom examined my joints.
There is so much I’d like to say to you – I used to think it was just me when all the rheumatologists I met acted that way – until I got messages from so many other patients that say the same thing – and then – I had the opportunity to observe how other patients are treated by watching interactions a few times – such as in an IV room – and we (I am never alone – often have 2 adults with me now) were stunned at what we observed. RA patients are routinely treated dismissively – and we were shocked even though we had heard the stories – seeing it first hand really opened my eyes to “it’s not just me.”
I’m sorry you were treated dismissively & I agree completely – that all we want is to be treated instead of dismissed. I don’t know whether this is a problem in other specialties but it seems systemic in ours. I wish you the best to find someone who will treat you asap – don’t give up!! There are good docs – you can even see stories about them on this page here today! If you want you can watch my video about this – it’s not pretty but it makes the point – https://www.rawarrior.com/video-rheumatoid-arthritis-doctors-treat-patients/ I talk about how happy we were when we met a dr who examined me instead of dismissing me.
I feel lucky to have found a really good rheumatologist on my second try. He does a joint exam and count at each visit and tells me what he found (current count 28 joints affected). He always has me fill out a HAQ and discusses the changes from the previous one. He figures the results and tells me what my “disability” number is and what it means (currently at a moderate level of disability). He writes letters to work for me. He also insists on seeing me at least after every other infusion (16 weeks). I like him a lot, but wonder how people with no insurance can find someone… I may be in that boat before long and it’s scary. The office visit alone is over $200!
Dr. Dagher examines each joint on each visit, has me fill out the daq/has. He records his findings, what my range of motionis in each joint ie the shoulders, elbow, wrists, make a fist, hips, knees and feet. He calcucates my score which is always high which correlates to the high inflammation markers ie sed and crp rate. Those never come down unfortunately. We discuss my meds, my over health, he asks questions about how I’m doing health wise from head to toe, just like they ask you when your admitted into the hospital. He also calls with my lab reports when the values are high and or too low, such as my potassium and vit d levels. I’m blessed to have him, I had to switch rheummy’s last year due to insurance reasons, and that rheummy never examined, looked at me from the door and went purely from the labs. I’m thankful I went back to reg medicare and have Dr. Dagher back. Thanks Kelly for the great blog.
My rheumatologist does not do a joint count or ask me to fill out papers. What he does do is sit in the room for at least ten to fifteen minutes and ask for an account of how RA is impacting me and how I feel the current medications are working. He then makes suggestions, “We could adjust this in this way and here are the pros and cons. . . . ” He remembers pertinent facts about my life before and after RA hit a year ago, and he remembers that for me the overwhelming fatigue has been more limiting and concerning than the pain, at least so far. He certainly gives me an active role in making decisions after he’s presented those pros and cons to me and given his suggestions for what choices he thinks might be best.
Hi Kelly, another excellent article to help us become more enlightened about this disease and how or how it is not being assessed. I supposedly am going to the best rheumatologist on the east coast. She’s got a great bedside manner but, I have never filled out any forms on my RA other than the standard new patient forms. A typical office visit includes her asking me how am I feeling, a look and a jiggle of my right hand, comparing my right hand to my left, bending my elbows, knees and ankles and listening to my heart and lungs. I’m not sure about the other states but NJ doctors are required to start using electronic medical records(EMR)which in my case means you talk, she types. It can be rather annoying since you loose eye contact and, in fact, at one visit I finally came out and asked her if she was playing a game on her computer. We both laughed but like most of my visits, I walk out of her office feeling like my office visit was a total waste of time and that this disease is no big deal, which we all know it is not. I’ve been diagnosed with RA now for a couple of years and am still totally confused.
Wow – thanks for your insightful & detailed comments, Pat. I hope you don’t stay feeling “totally confused” too long, but honestly the deeper I study this disease and hear what the experts are discovering, the more complex it seems and more importantly – the more I see that there is a chasm between the actual experience of the disease and what is known, written, and taught about it in medicine. The really don’t know about things that are very common to our experience – they just don’t know – unless they are very good listeners or have a close relative w/ RA. I’ve heard this sentiment also from physicians with RA.
im in new zealand, my doc does a joint count everytime i see her, i have aform to fill out each time,its posted to me aweek before i go to her.in the last two years ive had a knee and shoulder replacment done and my toes fixed on one foot, 3 big ops. i really feel for people in the states that have RA and the med care that you have to fight for, it blows me away how rough you have it
My Rheum Dr. Does have me fill out an evaluation form- it notes levels of pain- does bend my knees and lift my arms. I went to UT Southwest here in Dallas and was not impressed at all so went back to original Dr. Felt she was giving me more attention. She does sit and ask questions but not about my inability to work or be productive – my weight is really low and fatigue is bad- but if I am having a bad day I think of you, Kelly and all you do to keep this community informed and say to my self, if she can I can. LOL thanks
I think of you all too – it is a big help when I think I can’t take it any more – like I always say, “together we can do more.”
If this tells you anything…. I have no idea what your talking about! my doc does a quick look at my hands, tells me to squeeze, then runs his hand down the lower part of my leg to my ankle! Thats it! He has NEVER examined me! Looks in my throat, listens to my heart & lungs. So I have no clue what HAQ’s or the RAPID stuff is.
Pretty sad huh!
If you want to know more, you should read some of the links in the post – I think it’s pretty interesting stuff.
Sad, yes. Of course, what you describe is not an adequate exam for RA or any other rheumatic disease – but I believe you though because I’ve been there and heard it so many times from others.
Hmm, HAQ? RAPID? I don’t know. Counting? Nobody’s ever counted anything. First visit to both rheumies, I got a cute chart to circle joints that are affected, and I might as well just take a pen and color in the whole body. And then there is the form which asks how I felt the day of the visit, I think 10 questions where I rate my pain 1-10. Are either of those HAQ or RAPID? They both kind of looked at my knuckle joints. #2 said there is no synovitis (sp). Even hubs laughed at that. #1 said there was none the first visit, but he said he could see it the second visit (again, this is just my knuckles). Both swung my knees back and forth sideways a little bit. Uhm, I guess what I’m saying is, no, I don’t even know what these tests are, so 2 rheumies I’ve seen have not used them, I guess?
I am required to fill out paperwork every time I go in, but it is such a silly form that a lot of it doesn’t apply to me. Asks questions like am I able to participate in sports – I’m a 41 year old woman who has never participated in sports. Can I walk 2 miles? Am I able to turn the faucet on? Sure I can, but how about something more relevant? Am I able to get through an 8 hour day at work? Are my hands and finger joints in such severe pain that I am unable to type much (the thing I do most at work)? How about when I stand up from sitting at the computer am I hunched over and feeling like a 90 year old and for how long? Stupid, outdated form that bears little resemblance to a lot of real life activities.
That being said, my rheumatologist is the kindest man who actually listens and believes what I tell him. Believes I am in pain when I tell him, or that I am having joint swelling irregardless of the low CRP and ESR (have never had elevated crp or esr, even when I was unable to move my arms due to swelling in my shoulder, etc.), so I realize I am very lucky with such a great doctor.
Thank you for your funny & honest analysis of the HAQ’s – sounds like you read about the MDHAQ (the 2 miles). You hit the nail on the head with its relevance problems.
I guess I was one of the lucky ones as well with rheumys. Since I was seeing her every month, she was very aware of not only my rheumatological health but my health in general. One of the things I always made sure of was that all of my drs got reports from any testing, Xrays or procedures I had done so they were all on the same page. I would get an HAQ about every 3 months since I was there every month. My rheumy was very dilegent about checking my joints, I didn’t have to disrobe because I always made sure that I wore clothing, like knit fabric, that could be moved, felt thru or pushed up because I also was getting my Orencia infusion after my checkover by my doc. For me, it seems like I should be making it easier for everyone concerned, which in turn makes it easier for me, less tugging & pulling on my body. Some days, the act of disrobing alone is difficult. My doc looks at all of my joints, checks for synovitis and range of motion every visit. I had some abnormal test results for testing my GP had done and she asked me about how it was being addressed by my GP. I have to admit I am spoiled with my rheumy and my next job will probably be in Indianapolis so I am kind of apprehensive about having to change, but I have learned so much about things to know & do that I should be ok.
I fill out a form at every visit that details my symptoms between visits – don’t know if this is a standard form or not – but it does ask about pain, fatigue, joint swelling, etc. It also asks about all kinds of other health states. My rheumy does a full exam but does not have me disrobe unless he feels a need to examine a knee or shoulder more closely. I don’t know if he’s counting joints but he has remarked on the number of joints involved and the pattern so my thought is that he must have counted at some point.
None of the questions on the form ask about function – so I quess it’s not an HAQ.
I just read a Medscape CME for this exact topic, the routine care of RA patients. And, for the first time, I had the opportunity to discuss this, as well as other recent research, with my rheumatologist. Great discussion. One reason he gave me why he doesn’t use HAQ’s – which I have never filled one out in his office – is that most patients he sees have other conditions that would influence their answers, i.e., fibromyalgia, osteoarthritis, etc. Not to make the conversation turn into a defensive approach, as many times he has misdiagnosed my pain, I didn’t disagree with his reasoning. Of course, I do disagree and think all patients should at least have a baseline HAQ done and then one done at least annually or when medications are being changed or added. But he’s the doctor, and I am the patient. We also managed to talk about the slowly but surely change of thought about C1 and C2 being the only affected spinal areas by RA, that the synovial inflammation they find at facet joints may actually be attributed to RA…wow Kelly, progress!!!
I went to a seminar given by a rheumatologist and he said these measures will soon be required. Y the insurance companies. My rheumatologist does use them to track changes over time and has shown me periods when my subjective measures of pain and function were better or worse, which was helpful when the physical exam didn’t quite match. He also used it to show me when I had made some improvements. I think they canbe useful,and I would urge people to try to be truthful on them. I think my rheumy uses the haq but I am not sure, he also tends to focus his physical exam on the joints I mark as most painful, so I know he reads it.
Yes, my doctor, at Rheumatology Associates in Dallas, does the full RAPID3 at EVERY visit.
I love reading this site and am shocked at the varying levels of care people receive from rheumatologists. Of course it makes sense that each MD personalize his/her own way of doing things but RA disease treatment will not move forward if we aren’t all on the same page at a standard level of measurement and/or care with TREATMENT being the big variance suited to each RA patient’s need.
Thanks for posting! I think this helps push the ball forward toward a standard of care, showing other patients & drs what is being done. More to come on that very soon.
Never. I have never had any of that done, much less any questions about pain levels or abilities. I need a new doctor…
I have had 2 doctors and interviewed a couple others over the yrs. I haven’t had any of that done either. Including as you say, pain levels or funtional abilities questioned. I think treatment is based on swelling or photos of swelling if they allow that. Many doctors claim at meetings that “gestalt” impression is sufficient..
Good luck to you Megan.
I have never been evaluated in any quantitative way. I had xrays of my hands in 2004; no new ones for comparison since. I filled out an initial questionnaire with the outline of a person and marked where I felt pain (everywhere). Last time I saw the doctor (a new one for me), I was asked by the medical assistance to describe my pain 1 – 10. I asked “right now? this morning? since I saw the doctor last? which joint(s)?”
Good points.
2004 – that’s at least 8 years.
I am in Denver and go to a large Arthritis Clinic. My joints are examined each time and a count is done because he puts it in his notes which I get a copy of. I have never asked me to fill out either form but he asks me very extensive questions about my symptoms (better/worse etc.) I always get lab to make sure I am not developing some organ damage. He also goes over every drug I take to make sure he has them all listed and nothing changes. He pretty serious guy and I would like him to loosen up alittle but I think he does a good job of listening to me. His nurse that I talk to almost weekly is an angel.
Thanks Sue. That’s great he does a joint count. I’m wondering how is it that you talk with a nurse almost weekly? Are you in a study? (There are some great ones going on in Denver.) I’ve never seen a nurse in rheumatology but I know there are some and appointments are usually a minimum of 3 months apart.
There are so many things crowded onto these pages I can’t find the Assessment or anything I am looking for!!!!!!!!!!!!!!!!