Quantitative Clinical Rheumatology: “Keep It Simple, Stupid”: MDHAQ Function, Pain, Global, and RAPID3 Quantitative Scores to Improve and Document the Quality of Rheumatologic Care

Abstract

> “The KISS principle (acronym for “Keep It Simple, Stupid”) states that design simplicity should be a key goal and unnecessary complexity avoided.... Extra features are not needed; an approach that seems “too easy to be true” is in fact the best way.” The KISS principle (“Keep It Simple, Stupid”) has been applied effectively in many disciplines, including “software development, animation, photography, engineering, and strategic planning” (Wikipedia). In clinical medicine, perhaps the most elegant example of the KISS principle involves simple laboratory tests such as hemoglobin, creatinine, etc., that may be applied to diagnosis, prognosis, management, and documentation of outcomes of diseases. The discovery of rheumatoid factor (RF)1 and antinuclear antibodies (ANA)2 in 1949 raised hope that similar, simple biomarkers could be applied to diagnosis, prognosis, and management of inflammatory rheumatic diseases. Laboratory biomarkers provide an invaluable foundation to understand pathogenesis and develop new therapies, such as biological agents, and are informative in groups of patients. Nonetheless, laboratory tests have many limitations in the care of individual patients with rheumatic diseases. For example, in patients with rheumatoid arthritis (RA), RF is positive in only 69%3, anti-cyclic citrullinated peptide (anti-CCP) antibodies are positive in only 67%3, and erythrocyte sedimentation rate (ESR) is greater than 28 mm/h in only 60%4. Only about 1 in 50–100 people with … Address reprint requests to Dr. T. Pincus, NYU Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003. E-mail: tedpincus{at}gmail.com