Incorporating patient reported outcome measures in clinical practice: development and validation of a questionnaire for inflammatory arthritis.

BACKGROUND: Rheumatology is embarking on a fundamental redesign of rheumatic disease care. It has become mandatory not only to recognise disease activity core set data, but also the risks for other co-morbidities associated with inflammatory arthritis. Measurement of patient reported outcomes have become critical in both standard clinical practice and long term observational studies. OBJECTIVES: To assess validity, reliability and responsiveness to change of a patient self-reported questionnaire which can assess construct outcome measures of patients with inflammatory arthritis. METHODS: Four hundred and sixty-two patients with inflammatory arthritis were included in this work. The questionnaire was developed by integrating information obtained from patients suffering from inflammatory arthritis based on the Rasch model for ordered response options. The questionnaire includes assessment for functional disability, quality of life, VAS for joint pain, global status, fatigue, duration of morning stiffness, review of the systems, falls and cardiovascular risks, self-helplessness, as well as self reported joint pain. RESULTS: The questionnaire was reliable as demonstrated by a high-standardised alpha (0.891-0.992). The questionnaire items correlated significantly (p<0.01) with clinical parameters of disease activity. RA patient reported tender joints correlated significantly with the physician's scores (0.842). Changes in functional disability, quality of life as well as self-helplessness scores showed significant (p<0.01) variation with disease activity status. The PROMs questionnaire also showed a high degree of comprehensibility.(9.4). CONCLUSIONS: Integrating patient reported outcome measures into standard clinical practice is feasible and applicable. This version of a multidimensional questionnaire was found to be valid and reliable. It provides informative quantitative measures for the disease activity core set data, and in the mean time, facilitates assessing the patients' health related quality of life measure, cardiovascular and falls risks on an individual basis.

Acute pancreatitis associated with omeprazole.

Since their introduction in the late 1980s, proton pump inhibitors (PPI) have demonstrated gastric acid suppression superior to that of histamine H2-receptor blockers. This class of drugs has improved the treatment of various acid-peptic disorders, including gastroesophageal reflux disease, peptic ulcer disease, and nonsteroidal anti-inflammatory drug-induced gastropathy. PPIs have minimal side effects and few significant drug interactions. They are generally considered safe for long-term treatment. We present a rare side effect, acute pancreatitis, occurring in a patient who was treated with the proton pump inhibitor omeprazole.

Cross cultural adaptation and validation of the Arabic version of the Childhood Health Assessment Questionnaire for measuring functional status in children with juvenile idiopathic arthritis.

OBJECTIVE: To cross culturally adapt the American-English version of the Childhood Health Assessment Questionnaire (CHAQ) and to evaluate the validity and reliability of the modified translated version on children with juvenile idiopathic arthritis (JIA). METHODS: A cohort of 62 children suffering from JIA (32 Egyptian, 30 Saudi Arabian) were recruited and asked to participate in the study. Two questions had been changed to suit the Arabic culture and to tackle some aspects that are more typical of the Arabic culture. After modification, translation and back translation of the questionnaire, it was administered to the selected patients as well as their parents and tested for internal consistency, reliability and construct validity by correlating the yield of the questionnaire with other disease activity parameters. The questionnaire was administered again after a one-week interval for evaluation of the reliability of this test. The modified questions were tested for their loyalty to the principal component and their correlation with that of the other unchanged items was compared. RESULTS: CHAQ proved to be valid in clinically discriminating between healthy subjects and patients with different patterns of JIA. Test-retest showed strong reliability with a high percentage of agreement and high kappa values. Internal consistency showed a high value for the standardized Cronbach's alpha (0.951), and this value did not show any significant change when any one of the items was eliminated. The modified questionnaire showed a strong and significant validity when its results were correlated with disease activity parameters. CONCLUSION: The Arabic CHAQ is a reliable and valid instrument that can be administered to Arabic children suffering from JIA and to their parents, to evaluate the patients' functional disability. Its measurement properties were comparable to versions in other languages.