What is your practical approach to monitoring pruritus severity over time in PBC to guide treatment adjustments (e.g., daily vs interval numeric rating scales), especially when follow-up intervals are long and symptom scores can be variable?

I do not use rating scales outside the context of a research protocol.

I ask the patient about pruritus, I observe the patient in clinic (e.g., are they scratching), I examine the patient for excoriations, and I follow serum fractionated bile acids. I also tell them to message me if symptoms develop...