Session Information
Date: Tuesday, November 10, 2015
Title: Health Services Research Poster III: Patient Reported Outcomes, Patient Education and Preferences
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: RAPID3 is an index found on the MDHAQ, which is effective in rheumatoid arthritis (RA) clinical trials and clinical care (1). MDHAQ/RAPID3 also is informative in osteoarthritis (OA), ankylosing spondylitis (AS), gout, systemic lupus erythematosus (SLE) (2), and vasculitis (3). A reported clinical composite index for polymyalgia rheumatica (PMR) includes 3 patient reported measures, which are found on MDHAQ/RAPID3 (4). We analyzed whether MDHAQ/RAPID3 would be of value to document clinical improvement in clinical status over time in patients with PMR.
Methods: All patients with all diagnoses seen at an academic rheumatology center complete an MDHAQ/RAPID3 at all visits in the waiting area, before seeing the rheumatologist. The MDHAQ includes 0-10 scores for physical function (FN), pain (PN), patient global estimate (PATGL), compiled into a 0-30 RAPID3. The MDHAQ also scores fatigue, morning stiffness, and a RADAI self-report of painful joints which queries 16 joint groups bilaterally, including shoulders and hips, as well as demographic data. Prospectively-collected MDHAQ/RAPID3 data, as well as laboratory and medication data, of PMR patients seen between 2010 and 2014 were collected retrospectively from the medical record, including MDHAQ/RAPID3 scores, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and prednisone dosage. Data from a baseline visit and most recent visit over a mean interval of 15.5 months were compared for MDHAQ/RAPID3 scores, laboratory tests and medications. Statistical significance was analyzed using paired t-tests and chi-square tests.
Results: 34 patients with PMR seen in routine care were included in the study: 59% were females, 71% Caucasian, and mean age was 71.6 years. The mean duration from a baseline visit to most recent visit was 15.5 months (range 1 to 43 months). At initial presentation, mean RAPID3 was 12.2/30, physical function 2.2/10, pain 5.3/10, and PATGL 4.7/10, fatigue 3.9/10, and morning stiffness 63.1 minutes; 64.7% of the patients had painful hips, 79.4% had painful shoulders; 73.5% had abnormal ESR; 70.6% had abnormal CRP (Table). Significant improvement was seen between baseline and last visit in mean levels of RAPID3 and all other MDHAQ measures, except fatigue (p<0.05), as well as ESR and CRP (Table). The mean dose of prednisone was decreased from 12.2 at first visit to 4.3 mg at most recent visit.
Conclusion: In patients with PMR, improvement was seen according to MDHAQ/RAPID3 scores in a similar range to ESR and CRP, documenting effective response to prednisone. MDHAQ can be useful to document and monitor status of patients with PMR in busy clinical settings.
References: 1) Pincus T, et al. Bull NYU Hosp Jt Dis. 2012;70 Suppl 1:30-6. 2) Castrejon I, et al. J Clin Rheumatol: practical reports on rheumatic & musculoskeletal diseases. 2013;19(4):169-74. 3) Annapureddy N, et al. Clinical rheumatology. 2015. 40. 4) Leeb BF, Bird HA. Ann Rheum Dis 2004;63(10):1279-83.
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Table: Mean MDHAQ/RAPID3 scores, laboratory measures, and medication at baseline and most recent visit (mean 15.5 months later) in 34 patients with polymyalgia rheumatica |
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Baseline Visit N=34 |
Most Recent Visit N=34 |
Mean Change |
% Improvement |
p value |
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MDHAQ/RAPID3: Patient Self-report Scores |
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RAPID3, mean (SD) |
12.2 (7.0) |
8.5 (7.2) |
3.7 |
30.7% |
0.02 |
|
MDHAQ-Function, mean (SD) |
2.2 (2.1) |
1.5 (1.7) |
0.6 |
27.2% |
0.03 |
|
MDHAQ-Pain, mean (SD) |
5.3 (2.9) |
3.4 (3.4) |
1.9 |
35.8% |
0.002 |
|
MDHAQ-PATGL, mean (SD) |
4.7 (2.9) |
3.1 (3.1) |
1.6 |
34.0% |
0.01 |
|
RADAI-painful hip, n (%) |
22 (64.7%) |
12 (35.3%) |
29.4 |
45.4% |
0.02 |
|
RADAI-painful shoulder, n (%) |
27 (79.4%) |
17 (50%) |
10 |
37.0% |
0.02 |
|
MDHAQ-Fatigue, mean (SD) |
3.9 (3.6) |
3.5 (3.3) |
0.4 |
10.5% |
0.54 |
|
Morning stiffness duration, minutes, mean (SD) |
63.1 (97.7) |
19.1 (34.1) |
43.9 |
69.5% |
0.05 |
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Laboratory Measures |
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Abnormal ESR, n (%) |
25 (73.5%) |
14 (41.1%) |
32 |
43.5% |
0.007 |
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Abnormal CRP, n (%) |
24 (70.6%) |
13 (38.2%) |
32 |
45.3% |
0.007 |
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Medication |
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Prednisone dosage, mg, mean (SD) |
12.2 (6.8) |
4.3 (3.5) |
7.9 |
64.7% |
<0.001 |
To cite this abstract in AMA style:
Castrejón I, Huang A, Everakes SL, Nika A, Sequeira W, Pincus T. Documentation of Clinical Improvement in Patient with Polymyalgia Rheumatica According to MDHAQ/RAPID3 (Multidimensional Health Assessment Questionnaire/Routine Assessment of Patient Index Data): Longitudinal Analysis from Routine Care [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/documentation-of-clinical-improvement-in-patient-with-polymyalgia-rheumatica-according-to-mdhaqrapid3-multidimensional-health-assessment-questionnaireroutine-assessment-of-patient-index-data-long/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/documentation-of-clinical-improvement-in-patient-with-polymyalgia-rheumatica-according-to-mdhaqrapid3-multidimensional-health-assessment-questionnaireroutine-assessment-of-patient-index-data-long/