Inflammatory Joint Disease
The Gestaltometer allows collection of the core data set for patients with rheumatoid arthritis, by doctors, nurses, therapists and other clinicians.
Whilst tight control has undoubtedly been shown to result in better outcomes, defining the goal of therapy remains an art in different patients. The underlying philosophy of this tool is that Remission and Low Disease Activity are desirable but not always achievable, and a state of moderate disease activity may occasionally be acceptable in a patient with a small number of risk factors or where a patient declines additional medication.
The tool aims to guide clinicians about the potential need for a change in medication, and ensures collection of a complete data set. [It does not take the place of Nationally accepted tools or specialist opinion, but it does provide an interesting insight in to the gestalt decision making process.]
If the patient has more than three of the following risk factors then we will aim for tight control (ie a CDAI of low or remission) and may make an early decision to escalate therapy.
- Positive rheumatoid factor
- Positive anti CCP
- Swollen joint count > 3
- Radiologicial evidence of erosion
- CRP > 10
- Positive Power Doppler signal on ultrasound of active joints
Guide to completing the form
- We regard swelling as implying synovial thickening rather than including bony swelling (i.e. a Heberden node does not count in the swollen joint count, as we are trying to identify active joints)
- Just leave missing fields blank – the gestaltometer will still offer a guide to therapy
- Steroids count as a strong negative value owing totheir relative toxicity and the implication that it is aggressive disease that required their use.
- Previous erosive disease predicts future damage and hence always weights the final score negatively
- The CDAI, SDAI, DAS 28 and the Gestaltometer “opinion” will be shown on the submitted form if the relevant data have been included
CLICK HERE to access the form – You may print this form out, send it to a chosen e mail address as a PDF or if this is my patient submit it to me over a secure network if you have password permission.
At present the joint diagrams (homunculi) function best on Firefox but will work on other browsers
The original tool was paper based and has gone through 16 different transitions during development. The original Colour coded form worked well but was expensive to produce and copy in to electronic charts. We evolved through an RA collection form to the current web based tool.