Polymorphisms of the FCRL3 gene in a Spanish population of systemic lupus erythematosus patients.

Patients' own ability to assess activity of their rheumatoid arthritis SIR, Increasingly patients are able to access their Rheumatology Department via nurse-led Rheumatology helplines and, due to the over-booking of our clinics and the long distances patients have to travel to attend, there clearly is a potential for departments to develop a telephone follow-up service for patients with rheuma-toid arthritis (RA). Published work on Rheumatology telephone follow up concentrates on a doctor-rather than nurse-led service [1] and we have been unable to find any literature on patients' ability to assess their own disease activity on the telephone, although there is work on patients' assessment of Disease Activity Score (DAS) using a mannequin [2]. We therefore undertook a pilot study to assess this fact. We chose DAS28 as a measure of disease activity as it is a validated score for both the early and the established RA [3] and has been shown to be sensitive to change [4]. Patients attending the nurse consultant, nurse specialist and the specialist registrar clinics at Worcestershire Royal Hospital over the summer of 2005 with a diagnosis of RA were invited to participate in this study. They were asked to count the number of their tender and swollen joints using only verbal clues as to which joint, and then gave a numerical global health assessment from 0–100. The health care practitioner (HCP) then undertook a standard DAS28 assessment with global health assessment measured on a visual analogue scale and later calculated both the scores. Changes in medication and investigations requested were also noted. A total of 50 patients were recruited (of which 32 were female; age: mean and median 59 yrs; range 31–83). The disease duration ranged from 6 months to 32 yrs with a mean of 12 and a median of 11 yrs. Of the 50 patients, 39 were on one disease modifying drug (DMARD), six were on two and five on none. Two patients were also taking an anti-TNF therapy. The results of verbal DAS28 (vDAS28) and standard DAS28 were distributed normally with a mean vDAS28 score of 4.2 with a range of 0.46–8.54, and a mean DAS28 of 3.99 with a range of 0.76–6.68. The correlation between the scores was good with an R value of 0.895. Bland Altman plot analysis did not suggest whether the patients were more or less likely to overestimate DAS28 score at differing levels of disease activity. Interestingly …