Most visits of most patients with rheumatoid arthritis to most rheumatologists do not include a formal quantitative joint count

Results. In patients with RA, SLE, OA, PsA, and gout, mean RADAI scores (range 0 -48) were 12.4, 6.5, 10.1, 6.7, and 2.7, respectively. The mean numbers of involved joint groups (range 0 -16) were 6.9, 3.8, 4.8, 4.5, and 1.7, respectively, and the median numbers were 6, 2, 4, 4, and 1, respectively. RADAI scores were correlated significantly with the physician global estimate, except in SLE, and at higher levels with the MDHAQ and RAPID3 scores in all diagnostic groups. Conclusion. The RADAI self-report joint counts can be used to record self-report involvement of specific joints and joint groups in patients with SLE, OA, PsA, and gout, with minimal effort on the part of the rheumatologist.

Section: Discussionmentioning

confidence: 99%

Patient self‐report RADAI (Rheumatoid Arthritis Disease Activity Index) joint counts on an MDHAQ (Multidimensional Health Assessment Questionnaire) in usual care of consecutive patients with rheumatic diseases other than rheumatoid arthritis

Castrejón¹,

Yazıcı²,

Pincus³

2013

“…The only quantitative data collected at most usual care visits are laboratory tests, because other quantitative RA core data set measures (2-4) of formal joint counts (5) or patient questionnaire scores (6) are not included. Most routine rheumatology care has not changed over many years, with decisions largely based on nonquantitative impressions, despite evidence of the value of quantitative measures to recognize poor long-term outcomes (7)(8)(9) and use of the Disease Activity Score (DAS28) to improve outcomes in RA clinical trials (10 -18).…”

Section: Introductionmentioning

confidence: 99%

RAPID3 (Routine Assessment of Patient Index Data) on an MDHAQ (Multidimensional Health Assessment Questionnaire): Agreement with DAS28 (Disease Activity Score) and CDAI (Clinical Disease Activity Index) activity categories, scored in five versus more than ninety seconds

Pincus¹,

Swearingen²,

Bergman³

et al. 2010

102

, and time to score. Methods. Four rheumatologists each assessed 50 patients with rheumatoid arthritis in "real-time" clinical care. Patients completed an MDHAQ. The rheumatologist then calculated RAPID3 (physical function, pain, patient global estimate), performed a 28-joint count, assigned a physician global estimate, and scored a CDAI, each timed by an observer. Erythrocyte sedimentation rate (ESR) was tested on the same date, and the DAS28-ESR was computed later, again timed by an observer. Spearman's rank-order correlations and comparisons of patients classified as high activity, moderate activity, low activity, and remission according to the DAS28, CDAI, and RAPID3 were computed and compared with kappa statistics. A second study of 25 "paper patients" was also performed to compare time to score the DAS28, CDAI, and RAPID3 on a 0 -10 versus 0 -30 scale. Mean and median times to score each index were computed. Results. The 3 indices were correlated significantly, including agreement for >80% of patients for high/moderate activity. The mean time to perform a 28-joint count was 94 seconds, and the mean times to score the DAS28, CDAI, RAPID3 on a 0 -10 scale, and RAPID3 on a 0 -30 scale were 114, 106, 9.6, and 4.6 seconds, respectively. Conclusion. RAPID3 scores provide similar quantitative information to DAS28 and CDAI, while calculated on a 0 -30 scale in about 5% of the time.

“…Both DAS28 and CDAI require a formal joint count, the most specific measure for RA (6). However, formal joint counts are not performed at most visits to a rheumatologist unless required for clinical research or reimbursement (7).…”

Section: Introductionmentioning

confidence: 99%

RAPID3 (Routine Assessment of Patient Index Data 3) severity categories and response criteria: Similar results to DAS28 (Disease Activity Score) and CDAI (Clinical Disease Activity Index) in the RAPID 1 (Rheumatoid Arthritis Prevention of Structural Damage) clinical trial of certolizumab pegol

Pincus

Furer

Keystone

et al. 2011

Results. All measures were correlated significantly: RAPID3 with DAS28 and CDAI (rho > 0.7), higher than erythrocyte sedimentation rate with C-reactive protein level (rho ‫؍‬ 0.47). At 52 weeks, DAS28, CDAI, and RAPID3 low activity/ remission was seen in 30%, 44%, and 42% of CZP-treated patients versus 3%, 7%, and 10% of control patients. Good, moderate, and poor EULAR-DAS28 responses were seen in 30%, 51%, and 19% of CZP-treated patients versus 3%, 28%, and 70% of control patients, and for RAPID3 in 39%, 30%, and 32% of CZP-treated patients versus 8%, 16%, and 76% of control patients. Kappa and weighted kappa values ranged from 0.36 -0.53, indicating fair to moderate agreement. Conclusion. RAPID3, DAS28, and CDAI give similar results to distinguish CZP patients from controls in the RAPID 1 clinical trial. DAS28 is specific for clinical trials; RAPID3 appears pragmatically useful for usual care.