Multidimensional Health Assessment Research Articles

E80. Secondary Fibromyalgia in Patients with Other Rheumatic Diagnoses: Clues for Recognition on a Multidimensional Health Assessment Questionnaire and Physician Rheumdoc Checklist

E80. Secondary Fibromyalgia in Patients with Other Rheumatic Diagnoses: Clues for Recognition on a Multidimensional Health Assessment Questionnaire and Physician Rheumdoc Checklist

088. How much does Fatigue Contribute to the Physician Global Estimates in Different Rheumatic Diseases? Data from Routine Care on a Multidimensional Health Assessment Questionnaire

088. How much does Fatigue Contribute to the Physician Global Estimates in Different Rheumatic Diseases? Data from Routine Care on a Multidimensional Health Assessment Questionnaire

232. Clues to Recognize Fibromyalgia from a Patient Self-Report Multidimensional Health Assessment Questionnaire and Physician Rheumdoc

232. Clues to Recognize Fibromyalgia from a Patient Self-Report Multidimensional Health Assessment Questionnaire and Physician Rheumdoc

An external validation study reporting poor correlation between the claims-based index for rheumatoid arthritis severity and the disease activity score.

IntroductionWe conducted an external validation study to examine the correlation of a previously published claims-based index for rheumatoid arthritis severity (CIRAS) with disease activity score in 28 joints calculated by using C-reactive protein (DAS28-CRP) and the multi-dimensional health assessment questionnaire (MD-HAQ) physical function score.MethodsPatients enrolled in the Brigham and Women’s Hospital Rheumatoid Arthritis Sequential Study (BRASS) and Medicare were identified and their data from these two sources were linked. For each patient, DAS28-CRP measurement and MD-HAQ physical function scores were extracted from BRASS, and CIRAS was calculated from Medicare claims for the period of 365 days prior to the DAS28-CRP measurement. Pearson correlation coefficient between CIRAS and DAS28-CRP as well as MD-HAQ physical function scores were calculated. Furthermore, we considered several additional pharmacy and medical claims-derived variables as predictors for DAS28-CRP in a multivariable linear regression model in order to assess improvement in the performance of the original CIRAS algorithm.ResultsIn total, 315 patients with enrollment in both BRASS and Medicare were included in this study. The majority (81%) of the cohort was female, and the mean age was 70 years. The correlation between CIRAS and DAS28-CRP was low (Pearson correlation coefficient = 0.07, P = 0.24). The correlation between the calculated CIRAS and MD-HAQ physical function scores was also found to be low (Pearson correlation coefficient = 0.08, P = 0.17). The linear regression model containing additional claims-derived variables yielded model R2 of 0.23, suggesting limited ability of this model to explain variation in DAS28-CRP.ConclusionsIn a cohort of Medicare-enrolled patients with established RA, CIRAS showed low correlation with DAS28-CRP as well as MD-HAQ physical function scores. Claims-based algorithms for disease activity should be rigorously tested in distinct populations in order to establish their generalizability before widespread adoption.

Use of Dietary Supplements in Individuals with Rheumatoid Arthritis

Rheumatoid arthritis (RA) is an autoimmune disease accompanied by pain, joint stiffness, swelling, impacting quality of life. Individuals with RA may turn to complementary health approaches, including dietary supplements, as a possible way to manage their disease. The purpose of this study was to examine dietary supplement use among individuals with RA (n=84; age 53 ± 14 y; BMI 29.8 ± 7.7 kg/m2; duration of disease 13.7 ± 9.2 y). Height and weight were measured. Patients completed 7‐ day weighed food records and were interviewed about their use of dietary supplements. Disease activity was assessed using the Multi‐Dimensional Health Assessment Questionnaire, C‐reactive protein, and erythrocyte sedimentation rate. The individuals with RA in this study reported using 3 ± 4 dietary supplements per day. There were no significant relationships between disease activity, duration of disease, age, and mean number of dietary supplements used per day. However, 68 of the study participants (81%) reported daily dietary supplement use, including vitamins (n=52 [62%]), minerals (n=36 [43%]), multivitamin and mineral formulations (n=41 [49%]), herbal remedies (e.g., resveratrol, grape seed extract) (n=12 [14%]), amino acids (n=3 [4%]), dietary substances (e.g., fish oils) (n=26 [31%]), and other compounds (e.g., Co‐enzyme Q10, glucosamine) (n=17 [20%]). Unfortunately, only limited research has examined the safety, efficacy, and potential interactions of dietary supplements with conventional treatments for RA. Because individuals with RA frequently use dietary supplements, more research is needed.

Associations of toll-like receptor (TLR)-4 single nucleotide polymorphisms and rheumatoid arthritis disease progression: an observational cohort study.

To examine the associations of toll-like receptor (TLR)-4 single nucleotide polymorphisms (SNPs) with disease progression in rheumatoid arthritis (RA). A total of 1188 RA patients were genotyped for TLR4 SNPs (rs1927911, rs11536878, and rs4986790). Measures of disease activity were examined, including Disease Activity Score-28 (DAS28), Multidimensional Health Assessment Questionnaire (MD-HAQ), Clinical Disease Activity Index (CDAI), and Simplified Disease Activity Index (SDAI). Genetic associations with these longitudinal measures were examined using generalized estimating equations in both univariate and multivariate analyses. Analyses were then stratified by antigen specific anti-citrullinated peptide antibody (ACPA) status including antibody to citrullinated fibrinogen and citrullinated histone H2B. Disease activity measures progressed less over time in the homozygous minor allele group of rs1927911 including DAS28 (p<0.001), CDAI (p=0.008), and MD-HAQ (p=0.015) in univariate analysis and DAS28, CDAI and SDAI in multivariate analysis. Disease activity progression among those homozygous for the minor allele tended to be lower in the groups with positive ACPA though major differences by autoantibody status were not identified. There were no associations of TLR4 rs11536878 and rs4986790 SNPs with RA disease activity progression. In this population, TLR4 rs1927911 genotypes are associated with disease activity independent of other covariates.

Effect of Formal Education Level on Measurement of Rheumatoid Arthritis Disease Activity

Objective. The aim of this study is to analyze the capacity of three demographic variables - age, sex, and formal education level - as well as disease duration to explain variation in 7 Core Data Set variables and 4 indices used to assess rheumatoid arthritis (RA), in a cohort of Korean patients seen in usual care. Methods. All RA Core Data Set measures were collected in usual care of 397 RA patients, including tender/swollen joint counts (TJC, SJC) 28, physician global estimate of status, erythrocyte sed- imentation rate, C-reactive protein, and a multidimensional health assessment questionnaire to assess physical function, pain, and patient global estimate of status (PATGL). Four indices were computed: disease activity score with 28 joint count (DAS28), simplified disease activity index (SDAI), clinical disease activity index (CDAI), and routine assessment of patient index data 3 (RAPID3). Descriptive statistics and multivariate generalized linear models were used in data analysis. Results. Patients with lower education had higher scores, indicating greater severity, for all 7 Core Data Set measures and 4 indices (significant for TJC, function, pain, PATGL, DAS28, SDAI, CDAI, RAPID3). In a series of regressions that included age, sex, disease duration, and education, formal education level was the only significant variable to explain variation in TJC, pain, PATGL, physician global estimate of status (DOCGL), DAS28, SDAI, CDAI, and RAPID3. Conclusion. Significant associations with education were found in Korean RA patients according to most RA Core Data Set measures and 4 indices. Education was more likely than age, sex, or disease duration to explain variation in most measures and indices. (J Rheum Dis 2015;22:231-237)

Are patient self-report questionnaires as "scientific" as biomarkers in "treat-to-target" and prognosis in rheumatoid arthritis?

Information from patients traditionally is regarded as "subjective," in contrast to "objective," "scientific" laboratory data. However, patient questionnaire scores for physical function are more significant to predict severe outcomes of rheumatoid arthritis (RA), such as work disability and mortality, than radiographs or laboratory tests. Furthermore, the 3 RA Core Data Set patient self-report measures of physical function, pain, and patient global estimate are as effective as radiographs or laboratory tests to distinguish active from control treatments in clinical trials. A multidimensional health assessment questionnaire (MDHAQ) has been developed in routine clinical care, to be completed by patients in 5-10 minutes and contribute to clinical decisions, in contrast to research questionnaires which may provide extensive information, but often are lengthy, unfeasible for routine care, and not designed to add to clinical care. RAPID3 (routine assessment of patient index data) is an index included on the MDHAQ which is calculated in 5 seconds, compared with almost 2 minutes for RA indices that require a formal joint count, such as DAS28 (disease activity score with 28-joint count) or CDAI (clinical disease activity index). MDHAQ with included RAPID3 scores appears as "scientific" as laboratory tests, formal joint counts, and indices such as DAS28 and CDAI, to assess patient status using standard, protocolized, quantitative measurement. MDHAQ/RAPID3 helps the patient prepare for the visit, enhances doctor-patient communication, and saves time for the physician. MDHAQ/RAPID3 is useful in all rheumatic diseases, and can be incorporated into routine clinical care with minimal extra work for physicians and staff. MDHAQ in no way prevents collection of formal joint counts, radiographs and other imaging studies, laboratory tests, or any other information regarded as important by a rheumatologist. MDHAQ provides quantitative, "scientific" data, rather than gestalt impressions, regarding patient status, change in status, prognosis, and outcomes of RA and all rheumatic diseases.

Magnitude of fragility fracture risk in the very old--are we meeting their needs? The Newcastle 85+ Study.

Fractures due to osteoporosis are common in older people. This study assessed the management of osteoporosis in a group of 85-year-olds and found both assessment and current treatment to be suboptimal. Fragility fractures are a major cause of excess mortality, substantial morbidity, and health and social service expenditure in older people. However, much less is known about fracture risk and its management in the very old, despite this being the fastest growing age group of our population. Cross-sectional analysis of people who reached the age of 85 during the year of 2006 was carried out. Data were gathered by general practice record review (GPRR) and a multidimensional health assessment (MDHA). Seven hundred thirty-nine individuals were recruited. Mean age was 85.55 years (SD 0.44), and 60.2% were female; 33.7% (n = 249) had experienced one or more fragility fractures (F 45.2% vs M 16.3% p < 0.001); in total, 332 fractures occurred in these 249 individuals. A formal documented diagnosis of osteoporosis occurred in 12.4%, and 38% of individuals had experienced a fall in the last 12 months. When the fracture risk assessment tool (FRAX) and National Osteoporosis Guideline Group (NOGG) guidelines were applied, osteoporosis treatment would be recommended in 35.0%, with a further 26.1% identified as needing bone mineral density (BMD) measurement and 38.9% not requiring treatment or BMD assessment. Women were more likely than men to need treatment (47.4 vs 16.3%, p < 0.001, odds ratio (OR) 4.62 (3.22-5.63)) and measurement of BMD (40.0 vs 5.1%, p < 0.001, OR 12.4 (7.13-21.6)). Of the 259 individuals identified as requiring treatment, only 74 (28.6%) were on adequate osteoporosis treatment. The prevalence of high fracture risk in the very old is much higher than the documented diagnosis of osteoporosis or the use of adequate treatments.

The Past versus the Present, 1980-2004: Reduction of Mean Initial Low-Dose, Long-Term Glucocorticoid Therapy in Rheumatoid Arthritis from 10.3 to 3.6 mg/Day, Concomitant with Early Methotrexate, with Long-Term Effectiveness and Safety of Less than 5 mg/Day

Quantitative observations are presented concerning treatment with glucocorticoids of 308 patients with rheumatoid arthritis (RA) at a weekly academic rheumatology setting over 25 years from 1980 to 2004. A database of all visits included medications and multidimensional health assessment questionnaire scores for physical function, pain and routine assessment of patient index data (RAPID3; and a surrogate RAPID3-EST), completed by each patient at each visit in routine care. Over the 5-year periods of 1980-1984, 1985-1989, 1990-1994, 1995-1999 and 2000-2004, the mean initial prednisone daily dose declined from 10.3 to 6.5, 5.1, 4.1 and 3.6 mg/day, as initial doses were >5 mg/day in 49, 16, 7, 7 and 3% of patients, 5 mg/day in 51, 80, 70, 26 and 10%, and <5 mg/day in 0, 4, 23, 67 and 86%. Reduction of prednisone doses in the respective five-year periods was accompanied by increased and earlier use of methotrexate as the first disease-modifying antirheumatic drug (DMARD) in 10, 26, 57, 71 and 78%, and methotrexate treatment in 10, 26, 74, 82 and 92% of patients within the first year of disease. Higher methotrexate doses in the respective five-year periods were used after 1990, along with lower prednisone doses. Most patients were treated indefinitely with both low-dose prednisone and methotrexate; 80% continued both medications for more than 5 years. The primary adverse events were skin-thinning and bruising. New hypertension, diabetes and cataracts were seen in fewer than 10% of patients. While efficacy and safety cannot be analyzed definitively from observational data, the data suggest that many patients with RA might be treated effectively with weekly low-dose methotrexate along with initial and long-term, low-dose prednisone of <5 mg/day.

Validation of RAPID3 using a Japanese version of Multidimensional Health Assessment Questionnaire with Japanese rheumatoid arthritis patients: Characteristics of RAPID3 compared to DAS28 and CDAI

Objectives. To validate Routine Assessment of Patient Index Data 3 (RAPID3) using a Japanese version of Multidimensional Health Assessment Questionnaire (MDHAQ) with Japanese rheumatoid arthritis (RA) patients and to describe the characteristics of RAPID3 by comparison with Disease Activity Score 28 (DAS28) and Clinical Disease Activity Index (CDAI).Methods. The original MDHAQ was translated into Japanese with minor cultural modifications and was translated back in English. Test–retest reliability was evaluated in 50 Japanese RA patients and further validation was performed in 350 Japanese RA patients recruited by seven rheumatologists. RAPID3, CDAI, and DAS28 were assessed on two consecutive visits.Results. The test–retest reliability and the internal reliability of RAPID3 were excellent. Spearman's correlation coefficients between RAPID3 score versus CDAI score and DAS28 score were 0.761and 0.555. However, the agreement measured by kappa (weighted) for RAPID3 category versus CDAI category and for RAPID3 category versus DA28 category were 0.225 (0.382) and 0.187 (0.336). The sensitivity and specificity of “RAPID3 ≤ 3 and swollen joint ≤ 1” for predicting Boolean remission were 90.0% and 93.4%, respectively.Conclusions. RAPID3 obtained by Japanese MDHAQ was validated with Japanese RA patients and the remission criteria were found to have excellent clinical utility in usual care.

SAT0093 Association of Formal Education Level (EDUC) with Clinical Status in Korean Fibromyalgia (FM) Patients

BackgroundLow formal education level (EDUC), an indicator of socioeconomic status, is an established risk factor to develop rheumatoid arthritis (RA) as well as many other diseases,1 and low EDUC is...

FRI0141 Rapid3 in 90 Korean Patients with Ankylosing Spondylitis Yields Similar Information to BASDAI and Asdas, with Greater Feasibility for Busy Clinical Settings

BackgroundThe BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) is a self-report index to assess disease activity in patients with ankylosing spondylitis (AS). The ASDAS (AS disease activity score) is recorded...

FRI0218 Patient Self-Reported Fatigue as A Differentiator in SLE Flares

BackgroundPatient reported outcome (PRO) tools are uniquely informative for management of systemic lupus erythematosus (SLE) patients. Fatigue is an important component of PRO. Patients with SLE experience significant fatigue and...

FRI0204 Patient Global Estimates of Status Vary More than Physician Global Estimates, and Estimates Become Increasingly Discordant from ONE Another at Both High and Low Extremes of Disease Activity

BackgroundGlobal estimates by both patient (PATGL) and physician (DOCGL) are concordant within 2 units on a 0-10 visual analog scale (VAS) in about 40-65% of encounters, while discordance of PATGL>DOCGL...

AB0255 Delay in Diagnosis from Onset of Symptoms by More than One Year in 48% of 177 Patients with Rheumatic Diseases, Including 36% in Patients with Rheumatoid Arthritis in Australia

BackgroundDelayed diagnosis is recognized in many rheumatic diseases. Early treatment is regarded as critical for optimal clinical outcomes in patients with inflammatory rheumatic diseases. We studied possible delay in diagnosis...

AB1080 Comparison of Physical Function in SLE and RA Using Mdhaq

BackgroundThe rheumatic diseases have significant impact on patients' physical function. Patient reported outcome (PRO) tools provide insight into physical function, and are the most significant clinical predictor of work disability...

FRI0176 Group Clinics for Rheumatoid Arthritis: A New Model of Care

BackgroundGroup clinics are an alternative model of care to 1:1 clinic appointments. They have been used extensively in the United States for diverse conditions, including diabetes & hypertension, but have...

FRI0189 Assessment of Exercise Status in Routine Care Using Mdhaq: Evidence That Initiating Exercise is Associated with Substantially Better Outcomes than NO Exercise

BackgroundExtensive evidence indicates major benefits of exercise in rheumatoid arthritis1 and many rheumatic diseases,2 not only for cardiovascular and general fitness, but also for better rheumatologic clinical status. Most reported...

THU0089 A Patient Reported Outcome Measures-Based Composite Index (RAPID3) for the Assessment of Disease Activity in Ankylosing Spondylitis

BackgroundThere are disease-specific activity measures for almost each rheumatic disease. Disease-specific questionnaires may be optimal for clinical trials and other research studies, but it is not feasible to have patients...