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Evaluation of disease activity in rheumatoid arthritis by Routine Assessment of Patient Index Data 3 (RAPID3) and its correlation to Disease Activity Score 28 (DAS28) and Clinical Disease Activity Index (CDAI): an Indian experience

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Abstract

Serial objective assessment of disease activity in rheumatoid arthritis (RA) is imperative to achieve remission. Routine Assessment of Patient Index Data 3 (RAPID3), an index without formal joint counts, appears attractive for evaluation of disease activity in RA patients in a busy clinical setting. This study aims to evaluate correlation and agreement of RAPID3 with Disease Activity Score 28 (DAS28) and Clinical Disease Activity Index (CDAI) in RA patients. All patients completed a Multidimensional Health Assessment Questionnaire (MDHAQ) at each visit. A physician/assessor 28-joint count and erythrocyte sedimentation rate were completed in 200 literate patients with RA to score DAS28, CDAI, and RAPID3. RAPID3 includes the three MDHAQ patient self-report RA core dataset measures for physical function, pain, and patient global estimate. Proposed RAPID3 (range, 0–30) severity categories of high (>12), moderate (6.1–12.0), low (3.1–6.0), and near remission (≤3) were compared to DAS28 (0–10) activity categories of high (> 5.1), moderate (3.21–5.1), low (2.61–3.2), and remission (≤ 2.6), and CDAI (0–76) categories of >22, 10.1–22.0, 2.9–10.0, and ≤2.8. Statistical significance was analyzed using Spearman correlations, cross-tabulations, and kappa statistics. Comparison of RAPID3 with DAS28 and CDAI indicated Spearman rank-order correlation coefficients for DAS28 with RAPID3 of 0.910, and for CDAI with RAPID3 of 0.907, all highly significant (P < 0.001). There was substantial agreement between RAPID3 and DAS28 (kappa value = 0.634, P < 0.001) and also between RAPID3 and CDAI (kappa value = 0.690, P < 0.001). Overall, 89–94 % of patients who met DAS28 or CDAI moderate/high activity criteria met similar RAPID severity criteria and 84–88 % who met DAS28 or CDAI remission/low activity criteria also met similar RAPID criteria. RAPID3 scores provide similar quantitative information to DAS28 and CDAI, and hence, is an informative index for evaluation of disease activity in RA in busy clinical settings.

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References

  1. Wolfe F, Cush JJ, O’Dell JR, Kavanaugh A, Kremer JM, Lane NE et al (2001) Consensus recommendations for the assessment and treatment of rheumatoid arthritis. J Rheumatol 28:1423–1430

    PubMed  CAS  Google Scholar 

  2. Fransen J, Stucki G, van Riel P (2002) The merits of monitoring: should we follow all our rheumatoid arthritis patients in daily practice? Rheumatology (Oxford) 41:601–604

    CAS  Google Scholar 

  3. Kiely PD, Brown AK, Edwards CJ, O’Reilly DT, Ostör AJ, Quinn M et al (2009) Contemporary treatment principles for early rheumatoid arthritis: a consensus statement. Rheumatology (Oxford) 48:765–772

    Google Scholar 

  4. van der Heijde DMFM, van’t Hof MA, van Riel PLCM et al (1990) Judging disease activity in clinical practice in rheumatoid arthritis: first step in the development of a disease activity score. Ann Rheum Dis 49:916–920

    PubMed  Google Scholar 

  5. Van Der Heijde DM, van’t Hof M, Van Riel PL, Van de Putte LB (1993) Development of a disease activity score based on judgment in clinical practice by rheumatologists. J Rheumatol 20:579–581

    PubMed  Google Scholar 

  6. Prevoo ML, van’t Hof MA, Kuper HH, Van Leeuwen MA, Van de Putte LB, Van Riel PL (1995) Modified disease activity scores that include 28-joint counts. Development and validation in aprospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 38:44–48

    PubMed  CAS  Google Scholar 

  7. Mottonen T, Hannonen P, Leirisalo-Repo M et al (1999) Comparison of combination therapy with single-drug therapy in early rheumatoid arthritis: a randomised trial. FIN-RACo Trial Group. Lancet 353:1568–1573

    PubMed  CAS  Google Scholar 

  8. Puolakka K, Kautiainen H, Möttönen T et al (2005) Early suppression of disease activity is essential for maintenance of work capacity in patients with recent-onset rheumatoid arthritis: five-year experience from the FIN-RACo trial. Arthritis Rheum 52:36–41

    PubMed  Google Scholar 

  9. Grigor C, Capell H, Stirling A et al (2004) Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): a single-blind randomised controlled trial. Lancet 364:263–269

    PubMed  Google Scholar 

  10. Goekoop-Ruiterman YPM, de Vries-Bouwstra JK, Allaart CF et al (2005) Clinical and radiographic outcomes of four different treatment strategies in patients with early rheumatoid arthritis (the BeSt study): a randomized, controlled trial. Arthritis Rheum 52:3381–3390

    PubMed  CAS  Google Scholar 

  11. Goekoop-Ruiterman YPM, de Vries-Bouwstra JK, Allaart CF et al (2007) Comparison of treatment strategies in early rheumatoid arthritis: a randomized trial. Ann Intern Med 146:406–415

    PubMed  Google Scholar 

  12. Verstappen SMM, Jacobs JWG, van der Veen MJ et al (2007) Intensive treatment with methotrexate in early rheumatoid arthritis: aiming for remission. Computer Assisted Management in Early Rheumatoid Arthritis (CAMERA, an open-label strategy trial). Ann Rheum Dis 66:1443–1449

    PubMed  CAS  Google Scholar 

  13. Pincus T, Yazici Y, Sokka T (2007) Quantitative measures of rheumatic diseases for clinical research versus standard clinical care: differences, advantages and limitations. Best Pract Res Clin Rheumatol 21:601–628

    PubMed  Google Scholar 

  14. Pincus T, Segurado OG (2006) Most visits of most patients with rheumatoid arthritis to most rheumatologists do not include a formal quantitative joint count. Ann Rheum Dis 65:820–822

    PubMed  CAS  Google Scholar 

  15. Aletaha D, Smolen J (2005) The Simplified Disease Activity Index (SDAI) and the Clinical Disease Activity Index (CDAI): a review of their usefulness and validity in rheumatoid arthritis. Clin Exp Rheumatol 23:S100–S108

    PubMed  CAS  Google Scholar 

  16. Yazici Y, Bergman M, Pincus T (2008) Time to score quantitative rheumatoid arthritis measures: 28-joint count, disease activity score, health assessment questionnaire (HAQ), multidimensional HAQ (MDHAQ), and routine assessment of patient index data (RAPID) scores. J Rheumatol 35:603–609

    PubMed  Google Scholar 

  17. Pincus T, Swearingen CJ, Bergman MJ, Colglazier CL, Kaell AT, Kunath AM et al (2010) 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. Arthritis Care Res 62:181–189

    Google Scholar 

  18. Pincus T, Swearingen CJ, Bergman M, Yazici Y (2008) RAPID3 (Routine Assessment of Patient Index Data 3), a rheumatoid arthritis index without formal joint counts for routine care: proposed severity categories compared to disease activity score and clinical disease activity index categories. J Rheumatol 35:2136–2147

    PubMed  Google Scholar 

  19. Saag KG, Teng GG, Patkar NM, Anuntiyo J, Finney C, Curtis JR et al (2008) American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. Arthritis Rheum 59:762–784

    PubMed  CAS  Google Scholar 

  20. Fransen J, van Riel PLCM (2006) DAS remission cut points. Clin Exp Rheumatol 24:S29–S32

    Google Scholar 

  21. Aletaha D (2006) Pooled indices to measure rheumatoid arthritis activity: a good reflection of the physician’s mind? Arthritis Res Ther 8:102–104

    PubMed  Google Scholar 

  22. Aletaha D, Smolen JS (2006) Remission of rheumatoid arthritis: should we care about definitions? Clin Exp Rheumatol 24:S45–S51

    Google Scholar 

  23. Pincus T, Swearingen C, Wolfe F (1999) Toward a multidimensional Health Assessment Questionnaire (MDHAQ): assessment of advanced activities of daily living and psychological status in the patient-friendly health assessment questionnaire format. Arthritis Rheum 42:2220–2230

    PubMed  CAS  Google Scholar 

  24. Pincus T, Sokka T, Kautiainen H (2005) Further development of a physical function scale on a multidimensional Health Assessment Questionnaire for standard care of patients with rheumatic diseases. J Rheumatol 32:1432–1439

    PubMed  Google Scholar 

  25. Pincus T, Bergman M, Sokka T, Roth J, Swearingen C, Yazici Y (2008) Visual analog scales in formats other than a 10 centimeter horizontal line to assess pain and other clinical data. J Rheumatol 35:1550–1558

    PubMed  Google Scholar 

  26. Yelin E, Meenan R, Nevitt M, Epstein W (1980) Work disability in rheumatoid arthritis: effects of disease, social, and work factors. Ann Intern Med 93:551–556

    PubMed  CAS  Google Scholar 

  27. Pincus T, Callahan LF (1993) What is the natural history of rheumatoid arthritis? Rheum Dis Clin North Am 19:123–151

    PubMed  CAS  Google Scholar 

  28. Wolfe F (1996) The natural history of rheumatoid arthritis. J Rheumatol Suppl 44:13–22

    PubMed  CAS  Google Scholar 

  29. Pincus T (2006) The DAS is the most specific measure, but a patient questionnaire is the most informative measure to assess rheumatoid arthritis. J Rheumatol 33:834–837

    PubMed  Google Scholar 

  30. Pincus T, Strand V, Koch G et al (2003) An index of the three core data set patient questionnaire measures distinguishes efficacy of active treatment from placebo as effectively as the American College of Rheumatology 20 % response criteria (ACR20) or the Disease Activity Score (DAS) in a rheumatoid arthritis clinical trial. Arthritis Rheum 48:625–630

    PubMed  CAS  Google Scholar 

  31. Pincus T, Amara I, Koch GG (2005) Continuous indices of Core Data Set measures in rheumatoid arthritis clinical trials: lower responses to placebo than seen with categorical responses with the American College of Rheumatology 20 % criteria. Arthritis Rheum 52:1031–1036

    PubMed  Google Scholar 

  32. Pincus T, Chung C, Segurado OG, Amara I, Koch GG (2006) An index of patient self-reported outcomes (PRO Index) discriminates effectively between active and control treatment in 4 clinical trials of adalimumab in rheumatoid arthritis. J Rheumatol 33:2146–2152

    PubMed  Google Scholar 

  33. Pincus T, Bergman MJ, Yazici Y, Hines P, Raghupathi K, Maclean R (2008) An index of only patient-reported outcome measures, routine assessment of patient index data 3 (RAPID3), in two abatacept clinical trials: similar results to Disease Activity Score (DAS28) and other RAPID indices that include physician-reported measures. Rheumatology (Oxford) 47:345–349

    CAS  Google Scholar 

  34. Wolfe F, Michaud K, Pincus T (2005) A composite disease activity scale for clinical practice, observational studies and clinical trials: the patient activity scale (PAS/PAS-II). J Rheumatol 32:2410–2415

    PubMed  Google Scholar 

  35. Pincus T (2008) Limitations of a quantitative swollen and tender joint count to assess and monitor patients with rheumatoid arthritis. Bull NYU Hosp Jt Dis 66:216–223

    PubMed  Google Scholar 

  36. Coury F, Rossat A, Tebib A, Letroublon MC, Gagnard A, Fantino B et al (2009) Rheumatoid arthritis and fibromyalgia: a frequent unrelated association complicating disease management. J Rheumatol 36:58–62

    PubMed  Google Scholar 

  37. Makinen H, Hannonen P (2009) How to assess patients with rheumatoid arthritis and concomitant fibromyalgia? J Rheumatol 36:9–11

    PubMed  Google Scholar 

  38. Pincus T, Wolfe F (2005) Patient questionnaires for clinical research and improved standard patient care: is it better to have 80 % of the information in 100 % of patients or 100 % of the information in 5 % of patients? J Rheumatol 32:575–577

    PubMed  Google Scholar 

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Disclosures

The authors have had full access to all the data in the study and thereby accept full responsibility for the integrity of the data and the accuracy of the data analysis. There are no conflicts of interest (both personal and institutional) for any of the authors regarding specific financial interests that are relevant to the work conducted or reported in this manuscripte.

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Authors and Affiliations

  1. Department of Medicine, Pt. B.D. Sharma PGIMS, 881/23, DLF Colony, Rohtak, Haryana, India, PIN 124001

    H. Singh

  2. Department of Medicine, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India, PIN 124001

    V. Gupta, S. Ray, P. Talapatra, M. Kaur, S. Arya, R. Mathur & N. Ghangas

  3. Department of Rheumatology, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India, PIN 124001

    H. Kumar

  4. Department of Medicine, Maharaja Agrasen Medical College, Agroha, Haryana, India

    S. Kumar

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  1. H. Singh
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  2. V. Gupta
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Correspondence to H. Singh.

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Singh, H., Gupta, V., Ray, S. et al. Evaluation of disease activity in rheumatoid arthritis by Routine Assessment of Patient Index Data 3 (RAPID3) and its correlation to Disease Activity Score 28 (DAS28) and Clinical Disease Activity Index (CDAI): an Indian experience. Clin Rheumatol 31, 1663–1669 (2012). https://doi.org/10.1007/s10067-012-2070-9

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  • DOI: https://doi.org/10.1007/s10067-012-2070-9

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