Background/Purpose: RAPID3 (routine assessment of patient index data) on a multi-dimensional health assessment questionnaire (MDHAQ) distinguishes active from control treatments in RA clinical trials as effectively as disease activity score 28 (DAS28) or clinical disease activity index (CDAI), and is informative to monitor patients with osteoarthritis, spondyloarthropathies, vasculitis, gout, etc. (1). Therefore, many versions of an electronic RAPID3 (eRAPID3) have been developed, although generally mutually incompatible, mimicking electronic medical records (EMRs), and not easily merged into an EMR or into multicenter databases to study patient outcomes (2). More recently, another index of MDHAQ scores, FAST3 (fibromyalgia assessment screening tool3), has been described, which agrees >80% with ACR fibromyalgia (FM) criteria to identify FM (3). Here, we assess eFAST3 and eRAPID3 on an eMDHAQ to recognize possible secondary FM in patients with osteoarthritis (OA) or rheumatoid arthritis (RA).

Methods: A patient- and doctor-friendly eMDHAQ meets HIPAA, privacy and security requirements, and is designed to interface with any EMR, using FHIR (Fast Healthcare Interoperability Resources) for integration and interoperability, although requiring collaboration with the EMR vendor, and to be merged easily into common collaborative research databases. eRAPID3 on an eMDHAQ is a 0-30 sum of a 0-10 physical function (FN) scale and two 0-10 visual analog scales (VAS) for pain (PN) and global assessment (PATGL). eFAST3 on eMDHAQ is a 0-3 scale; 1 point is assigned if PN ≥6/10, RADAI painful joint count ≥16/48, and MDHAQ symptom checklist ≥16/60; FAST3≥2 is clue to FM (3). eRAPID3 and eFAST3 were compared in 89 osteoarthritis (OA) vs 91 rheumatoid arthritis (RA) patients, using STATA to compute means and cross-tabulations.

Results: Mean eRAPID3 scores were 14.9 in OA vs 11.1 in RA patients. eRAPID3 was >12 (high severity) in 59 OA (66%) and 39 RA (43%) patients. eFAST3 ≥2, suggesting secondary FM, was seen in 21 of the 59 OA patients (24% of all OA patients) and 17 of the 39 RA patients (19% of all RA patients) with RAPID3>12 (Table). No patient with RAPID3 <12 had eFAST3 ≥2, suggesting a good screen for the absence of FM. Most patients with RAPID3>12 also had FAST3 <2 (Table), suggesting limited specificity of RAPID3 for FM.

Number of patients with OA or RA according to eRAPID3 vs eFAST3 on eMDHAQ.

(%) are of all OA or RA patients

Conclusion: An eMDHAQ offers reports of eRAPID3 and eFAST3 for improved clinical decisions, doctor-patient communication, and documentation. Further development of the eMDHAQ, eRAPID3, and eFAST3, and interface to the EMR, are needed for optimal value. Rheumatologists and organizations are encouraged to implement an electronic MDHAQ, rather than simply an electronic RAPID3.

References: 1. Current pharmaceutical design. 2015; 21:241-56. 2. Clin Exp Rheumatol. 2016; 34:S49-53. 3. EULAR. 2017. Poster THU0472

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/emdhaq-electronic-multidimensional-health-assessment-questionnaire-to-record-and-document-erapid3-electronic-routine-assessment-of-patient-index-data3-and-efast3-electronic-fibromyalgia-assessme/