RAPID3 Scores Research Articles

Evaluation of self-report questionnaires for assessing rheumatoid arthritis activity: A cross-sectional study of RAPID3 and RADAI5 and flare detection in 200 patients

Objectives To assess the validity of the two self-report questionnaires RAPID3 and RADAI5 for measuring the activity of rheumatoid arthritis (RA) in everyday practice, comparatively to the DAS28, CDAI, and SDAI. To determine cutoffs for flare detection based on patients’ and physicians’ opinions. Methods The RAPID3 and RADAI5 questionnaires were completed by 200 consecutive patients with RA. The DAS28, CDAI, and SDAI were computed in each patient. Patients and physicians stated whether a flare was occurring. Pairwise Spearman correlation coefficients were computed between the two scores and three indices. The kappa coefficient was used to assess agreement between the patients and physicians regarding the presence of a flare. Receiver-operating characteristic (ROC) curves were constructed to determine cutoffs for flare detection. Results The 200 patients had a mean age of 57 ± 11.5 years, a mean RA duration of 13 ± 8.3 years, a mean DAS28 of 3.61 ± 1.43, a mean CDAI of 12.7 ± 9.89, and a mean SDAI of 13.4 ± 10.45. The mean RAPID3 and RADAI5 scores were 3.45 ± 2 and 3.93 ± 2.18, respectively. The RAPID3 and RADAI5 scores correlated significantly with the three composite activity indices, with ρ values ranging from 0.64 to 0.74. The flare rate was 35% according to the patients and 22% according to the physicians, with moderate agreement between patients and physicians (κ = 0.44). Flare cutoffs with satisfactory sensitivity and specificity values were obtained for the two scores and three indices. For the three indices, flare cutoffs according to the physicians were within the range indicating moderate disease activity: 4.04 for the DAS28, 14.5 for the CDAI, and 16.7 for the SDAI. The RAPID3 and RADAI5 flare cutoffs according to the physicians and patients were similar, 4.27 and 4.33 for RAPID3 and 4.5 and 4.7 for RADAI5, respectively. Conclusion These results confirm the validity of the RAPID3 and RADAI5 self-report questionnaires and support their widespread use in everyday practice in patients with RA. The self-report questionnaire scores correlate with the composite activity index values and allow the detection of activity peaks or flares.

Quantitative Data for Care of Patients with Systemic Lupus Erythematosus in Usual Clinical Settings: A Patient Multidimensional Health Assessment Questionnaire and Physician Estimate of Noninflammatory Symptoms

To analyze quantitative data in patients with systemic lupus erythematosus (SLE), seen in usual care, from a patient Multidimensional Health Assessment Questionnaire (MDHAQ) with routine assessment of patient index data (RAPID3) scores and from a physician global estimate of noninflammatory symptoms; and to compare results to self-report Systemic Lupus Activity Questionnaire (SLAQ) scores and 4 SLE indices: SLE Disease Activity Index-2K (SLEDAI-2K), British Isles Lupus Assessment Group (BILAG), Systemic Lupus Activity Measure (SLAM), and European Consensus Lupus Activity Measurement (ECLAM). Fifty consecutive patients with SLE were studied in usual care of one rheumatologist. All patients completed an MDHAQ/RAPID3 in this setting. Each patient also completed a SLAQ. The rheumatologist scored SLEDAI-2K, BILAG, SLAM, ECLAM, and 2 physician global estimates, one for overall status and one for noninflammatory symptoms. Patients were classified into 2 groups: "few" or "many" noninflammatory symptoms. Scores and indices were compared using correlations, cross-tabulations and t tests. The patients included 45 women and 5 men. MDHAQ/RAPID3 and SLAQ scores were significantly correlated. RAPID3 scores were significantly higher in patients with SLE index scores above median levels, and in 34 patients scored by the rheumatologist as having "few" noninflammatory symptoms. MDHAQ/RAPID3 and SLAQ were significantly higher in 16 patients scored as having many noninflammatory symptoms. MDHAQ/RAPID3 and SLAQ subscale scores appear to reflect disease activity in patients with SLE, but not in patients with many noninflammatory symptoms. A physician scale for noninflammatory symptoms is useful to interpret MDHAQ/RAPID3, SLAQ, and SLE index scores.

Weekly home self-assessment of RAPID-4/3 scores in rheumatoid arthritis: A 6-month study in 26 patients

ObjectivesTo investigate whether weekly determination of Routine Assessment of Patient Index Data (RAPID) scores 3 and 4 in patients with rheumatoid arthritis (RA) improved the assessment of disease activity and detected additional activity peaks (predictive of additional structural damage). MethodsEach week for 6 months, 26 patients with RA completed the patient-reported outcome questionnaires RAPID-3 and RAPID-4. During the study period, the treatment regimen for RA remained unchanged in 23 of the 26 patients. ResultsRAPID-3 was as informative as RAPID-4. Mean values were 3.85±1.66 (range: 0.72–6.85) and 3.43±1.57 (range: 0.81–6.77), respectively. The areas under the RAPID-3 score curves plotted using only the first and last weeks or all the weeks showed a statistically significant difference in 19 (73%) of the 26 patients. The difference between the highest and lowest RAPID-3 scores was greater than the clinically significant threshold of 1.2 in all 26 patients (mean difference: 2.95±0.71; range: 1.6–5.5). In 13 patients, the RAPID-3 score detected one (one patient) or several (12 patients) activity peaks. Among RAPID-3 score components, the visual analog scale (VAS) pain score had the greatest influence (37% of the total score), followed by the VAS disease-activity score (36%) then by the multidimensional Health Assessment Questionnaire score (27%). Scores were not influenced by patient mood at questionnaire completion. ConclusionSelf-evaluation at home using the RAPID-3 score provides additional information that should improve the accuracy of RA monitoring between physician visits and that may help to optimize visit scheduling.

Reevaluation of the Role of Duration of Morning Stiffness in the Assessment of Rheumatoid Arthritis Activity

To evaluate the utility of the duration of morning stiffness (MS), as a patient-reported outcome (PRO), in assessing rheumatoid arthritis (RA) disease activity. We acquired information on 5439 patients in QUEST-RA, an international database of patients with RA evaluated by a standard protocol. MS duration was assessed from time of waking to time of maximal improvement. Ability of MS duration to differentiate RA activity states, based on Disease Activity Score (DAS)28, was assessed by analysis of variance; and a receiver-operating characteristic (ROC) curve was plotted for discriminating clinically active (DAS28 > 3.2) from less active (DAS28 <or= 3.2) RA. Mixed-effect analysis of covariance (ANCOVA) models were used to assess the utility of adding MS duration to Routine Assessment of Patient Index Data (RAPID)3, a PRO index based on physical function, pain, and general health (GH), in predicting the 3-variable DAS28 (DAS28v3). MS duration had moderate correlation (r = 0.41-0.48) with pain, Health Assessment Questionnaire, and GH; and weak correlation (r = 0.23-0.39) with joint counts and erythrocyte sedimentation rate. MS duration differed significantly among patients with different RA activity (p < 0.001). The area under the ROC curve of 0.74 (95% CI 0.72-0.75) showed moderate ability of MS duration to differentiate clinically active from less active RA. ANCOVA showed significant interactive effects between RAPID3 and the MS duration categories (p = 0.0005) in predicting DAS28v3. The effect of MS was found to be clinically important in patients with the low RAPID3 scores (< 6) in whom the presence of MS may indicate clinically active disease (DAS28v3 > 3.2). MS duration has a moderate correlation with RA disease activity. Assessment of MS duration may be clinically helpful in patients with low RAPID3 scores.

Quantitative Clinical Rheumatology: Why Is a Test for Anti-CCP Antibodies Included in Most Routine Care for Rheumatoid Arthritis While a HAQ/MDHAQ Remains Largely a Research Tool?

Quantitative assessment of rheumatoid arthritis (RA) has been greatly advanced over the last few decades by important new measures. In 1980, the Health Assessment Questionnaire (HAQ) was reported by Fries and colleagues1. Eighteen years later, anti-cyclic citrullinated peptides (anti-CCP) in RA were reported by Schellekens and colleagues2. Since 1980, the HAQ has been incorporated to provide 3 of the 7 Core Data Set measures for RA3, physical function, pain, and patient global estimate. The HAQ has been adapted for usual care as a modified HAQ (MHAQ), HAQ II, and multidimensional HAQ (MDHAQ)4. A HAQ/MDHAQ physical function score predicts severe longterm RA outcomes of work disability and premature mortality over 5–20 years at far higher levels of significance than radiographic scores or laboratory tests5. RAPID3 (Routine Assessment of Patient Index Data) scores of 3 HAQ/MDHAQ self-report measures distinguish active from control treatments in clinical trials as sensitively as joint counts, laboratory tests, and Disease Activity Score (DAS)286. RAPID3 is correlated significantly with DAS28 and the Clinical Disease Activity Index (CDAI) in clinical trials6 and clinical care7, and … Address reprint requests to Dr. T. Pincus, Division of Rheumatology, Room 1608, NYU Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003. E-mail: tedpincus{at}gmail.com

Is a Self-Report RAPID3 Score a Reasonable Alternative to a DAS28 in Usual Clinical Care?

From the Division of Rheumatology, NYU Hospital for Joint Diseases, New York, New York. Theodore Pincus, MD, Division of Rheumatology, NYU Hospital for Joint Diseases, 301 East 17th Street, Room 1608, New York, NY 10003. E-mail: [email protected]

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<h3>Background</h3> FLARE-RA (FLARE in Rheumatoid Arthritis) is a self-administered questionnaire developed to detect rheumatoid arthritis (RA) flare that has occurred in the meantime since the last visit to the physician¹. The questionnaire is based on 11 items or statements exploring both RA patients and physician perceptions of RA flare in the 3-month period before the consultation to the rheumatologist. The respondents are asked to rate their agreement on a 0-10 numerical rating scale (NRS). FLARE-RA score is the mean of the 11 NRS. FLARE-RA has already been shown to be unidimensional, reliable and good correlation with disease activity at the time of questionnaire filling². <h3>Objectives</h3> To assess the ability of the FLARE self-administered questionnaire to identify past flare in RA patients. <h3>Methods</h3> Study design was observational prospective 3-month study of patients with RA (satisfaction of 1987 ACR criteria, duration &gt;6 months) and treated with stable doses of DMARDs. Patients were seen at baseline and 3 months (M3). To identify past RA flare, i.e., transient disease activity increase occurring in the 3-month period before the M3 visit, patients were asked to fill in the RAPID3 self-administered questionnaire³ every week between baseline and M3. Spearman correlation coefficients were calculated to assess the association between the FLARE score at M3 and RAPID3-based past disease activity over the 3-month period between baseline and M3. The past disease activity was assessed by 3 different ways: area under the curve of RAPID3 scores (AUC), maximum RAPID3 value (MAX), and maximum delta of RAPID3 scores between 2 consecutive visits (DELTA MAX). The analysis was conducted in the whole population and in the subsample with low disease activity or remission at M3. <h3>Results</h3> 132 patients were recruited from 13 centres: 78.7% women, 57.7 years old, 84.4% RF+, 78.7% ACPA+, DAS28 was 2.9, CRP was 5.7 mg/l and 81.2% had erosive disease. Complete RAPID3 data were available for 96, of whom 54 (56%) were in remission or low disease activity at M3 visit. Whatever the method used, FLARE-RA scores were significantly correlated with RA disease activity over the 3-month period preceding the visit to the rheumatologist. <h3>Conclusions</h3> The FLARE-RA self-administered questionnaire can detect past RA flare and could represent a potential help to monitor disease activity between rheumatologist consultations and identify patients whose appointment should be anticipated or treatment revised <h3>References</h3> Berthelot JM et al. Ann Rheum Dis 2012; 71(7): 1110-61. Morel J et al. Arthritis Rheum 2013; 65(10): S1231. Pincus T, et al. Rheumatology (Oxford) 2008; 47(3): 345-9. <h3>Acknowledgements</h3> We thank Mrs Irawatti Lemonnier for coordination and management of the projet; Mrs Marie Line Epelding for stastistical analysis <h3>Disclosure of Interest</h3> None declared <h3>DOI</h3> 10.1136/annrheumdis-2014-eular.4614