What is a General Practitioner (GP) joint assessment?

GP Joint Assessment: A Comprehensive Approach to Evaluating Joint Health

A GP joint assessment refers to a systematic evaluation of joints performed by healthcare providers that includes both swollen and tender joint counts to assess disease activity in conditions like rheumatoid arthritis and other inflammatory arthropathies.

Components of a GP Joint Assessment

• Joint assessments should include evaluation of both swollen and tender joint counts, which are crucial for monitoring disease activity in inflammatory arthritis 1
• Swollen joint counts correlate with progression of joint damage, while tender joint counts relate to physical function 1
• The American College of Rheumatology recommends quantitative assessment using composite measures that incorporate joint counts for monitoring and treatment decisions 2

Standardized Assessment Tools

• Several validated composite measures incorporate joint assessments:

  • Clinical Disease Activity Index (CDAI): Includes 28 swollen joint count, 28 tender joint count, patient global assessment, and provider global assessment 1
  • Simplified Disease Activity Index (SDAI): Adds C-reactive protein to the CDAI components 1
  • Disease Activity Score with 28-joint counts (DAS28): Includes tender and swollen joint counts, patient global assessment, and an acute-phase reactant (ESR or CRP) 1

• These measures help categorize disease activity into remission, low/minimal, moderate, or high/severe 1

Joint Count Methodology

• Standard joint counts typically evaluate 28 joints, including:

  • Metacarpophalangeal joints
  • Proximal interphalangeal joints
  • Wrists
  • Elbows
  • Shoulders
  • Knees 3

• For conditions like psoriatic arthritis, a more comprehensive count may be needed:

  • 68/66 joints (tender/swollen) including DIP joints of hands and feet 1
  • Assessment for dactylitis (swollen digit) and enthesitis (inflammation at tendon insertion sites) 1

Clinical Significance

• Joint assessment is a critical component of the treat-to-target approach in inflammatory arthritis 1
• Regular joint assessments guide treatment decisions and help monitor response to therapy 1
• Swollen joint counts have been consistently shown to correlate with radiographic damage progression 1
• Formal joint assessment provides greater accuracy than patient-reported measures alone 1

Limitations and Considerations

• Provider joint counts are examiner-dependent and may be unreliable if the assessor changes 1
• Joint counts may not correlate completely with sonographic evidence of synovitis 1
• The choice of assessment tool should be influenced by comorbidities, patient factors, and drug-related risks 1
• Ultrasound and MRI may detect subclinical synovitis not evident on physical examination 1

Implementation in Practice

• Joint assessments should be performed regularly to monitor disease activity and guide treatment decisions 1
• The choice of instrument should be recorded in patient files 1
• Composite measures that include joint counts are preferred over measures that rely solely on patient-reported outcomes 1
• High-grade power Doppler signals on ultrasound correlate well with clinical joint swelling and disease activity 4