Can RAPID3, an index without formal joint counts or laboratory tests, serve to guide rheumatologists in tight control of rheumatoid arthritis in usual clinical care?
Tight control of rheumatoid arthritis (RA) may be guided by RAPID3 (routine assessment of patient index data), an index without formal joint counts or laboratory tests, which can be scored on a multidimensional health assessment questionnaire (MDHAQ) in 5 seconds, compared to 42 seconds to score a standard HAQ, 90 seconds to perform a 28-joint count, 114 seconds to score a disease activity score 28 (DAS28), and 106 seconds to score a clinical disease activity index (CDAI). RAPID3 scores are correlated significantly with DAS28 and CDAI (rho > 0.65, p < 0.001), and distinguish active from control treatment similarly to DAS28 and CDAI in clinical trials of methotrexate, lefunomide, adalimumab, abatacept, certolizumab, and infiximab. RAPID3 scores can be used to classify patient disease activity status as high (> 12), moderate (6.1-12), low (3.1-6), and remission (<or= 3), analogous to activity categories of DAS28 and CDAI. In clinical care settings, 78% to 84% of patients who met the criteria for moderate-high activity status of greater than 3.2 for DAS28 and greater than 10 for CDAI had RAPID3 scores greater than 6, while 68% to 77% who met low activity-remission criteria of a DAS less than or equal to 3.2 and a CDAI of less than or equal to 10 also had RAPID3 scores that were less than or equal to 6. The most effective strategy to collect MDHAQ-RAPID3 data is for the receptionist to ask each patient to complete a questionnaire upon registration at each visit, prior to seeing the physician in the infrastructure of clinical care. Clinical judgment ultimately enters into all clinical decisions, but judgment is enhanced considerably by quantitative data provided by the MDHAQ and RAPID3 to supplement nonquantitative impressions. RAPID3 provides a feasible, informative quantitative index for busy clinical settings.
New York University School of Medicine, New York, NY 10003, USA. tedpincus@gmail.com
Theodore
T
Pincus
D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000188:drug therapy; D002983:Clinical Competence; D004185:Disability Evaluation; D006305:Health Status Indicators; D006801:Humans; D007596:Joints / Q000473:pathology; D018579:Patient Selection; D011237:Predictive Value of Tests; D011787:Quality of Health Care; D012074:Remission Induction; D012219:Rheumatology / Q000379:methods* / Q000592:standards; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D018501:Antirheumatic Agents