Elsevier

Joint Bone Spine

Volume 77, Issue 6, December 2010, Pages 582-587
Joint Bone Spine

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

https://doi.org/10.1016/j.jbspin.2010.08.009Get rights and content

Abstract

Objectives

To 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).

Methods

Each 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.

Results

RAPID-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.

Conclusion

Self-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.

Section snippets

Methods

The study was approved by the Nantes ethics committee. Patients with RA were recruited from the patient organization Association française des polyarthritiques (Pays-de-Loire chapter), with the active assistance of the chair. We identified 27 volunteers who were willing to complete the RAPID questionnaires at home every week for 30 weeks. Each patient was given a booklet of RAPID-3 and RAPID-4 questionnaires and a patient information sheet for collecting informed consent. The questionnaire

Statistics

Relations between patient age, RA duration, and number of missing data were assessed using Pearson's test of zero correlation coefficient. To assess potential associations linking patient age, RA duration, and the RAPID-3 score, we used Poisson regression analysis. The contribution of the self-reported tender joint count used in RAPID-4 was evaluated by comparing the variances of the RAPID-3 and RAPID-4 scores. Linear regression was used to assess potential relations between the variance of the

Patient population

Of the 27 volunteers, 26 returned completed questionnaires. Mean age of these 26 patients was 56.5 ± 9.5 years (range: 41–77 years). All 26 patients had established RA, and mean disease duration was 16.6 ± 10.0 years. None of the patients reported being in remission; however, DAS28 scores were not available. The treatment regimen included methotrexate in 21 patients, prednisone in 18, a TNFα antagonist in six (etanercept in four and adalimumab in two), and leflunomide in two. During the 30-week

Discussion

Rheumatologists use the tender and swollen joint counts to quantify disease activity in patients with RA. The swollen joint count is not used in RAPID-4 and neither count is used in RAPID-3. Therefore, the relevance of RAPID-4 and RAPID-3 for assessing RA activity is not immediately obvious. However, we found that the tender joint subscore contributed only 17% of the total RAPID-4 score and had a smaller variance than the other three RAPID-4 subscores over the 30-week study period. Furthermore,

Conflict of interest statement

The authors have no conflict of interest to declare.

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