Background/Purpose: Patients with inflammatory arthritides may have secondary osteoarthritis (OA), which affects decisions concerning clinical management. For example, in one study, about 20% of patients with DAS28 scores >3.2, suggesting that therapy should be intensified according to treat-to-target, did not have intensification because of clinically important joint damage (1). We analyzed patient MDHAQ/RAPID3 scores and physician RheuMetric checklist estimates of damage (as well as overall global estimate, inflammation and distress) to identify and document secondary OA in patients with inflammatory arthritides seen in a busy clinical setting.

Methods: All patients seen at one rheumatology site complete a MDHAQ/RAPID3, and the rheumatologists complete a RheuMetric physician checklist. The MDHAQ includes scores for physical function (0-10), pain (0-10), and patient global estimate (PATGL) (0-10), compiled into a RAPID3 (0-30) score. The 1-page physician RheuMetric checklist includes a standard 0-10 visual analog scale (VAS) for physician global estimate (DOCGL), and 3 further 0-10 VAS for the levels of inflammation or reversible findings (DOCINF), damage or irreversible findings (DOCDAM), and patient distress (e.g. fibromyalgia, depression) (DOCDIS), as well as primary, secondary and tertiary rheumatic diagnoses. Patients with RA, ankylosing spondylitis, psoriatic arthritis, and inflammatory arthritis were classified as “inflammatory arthritides”, and were further classified as having or not having comorbid secondary OA. Mean MDHAQ scores and RheuMetric estimates were computed in the two groups; statistical significance was analyzed using 2-tailed t-tests with significance at p<0.05.

Results: Overall, 159 patients with inflammatory arthritides were studied, 31 with secondary OA and 128 with no secondary OA. Patients with secondary OA were older (p=0.043) and had marginally lower levels of education (p=0.267) (Table). All MDHAQ scores were higher in patients with comorbid OA, significantly for physical function (p=0.004) and pain (p=0.043). RAPID3 scores were 10.8 (moderate severity) in patients with no secondary OA and 14.1 in those with comorbid OA (p=0.026). Mean physician damage estimates were 2.9 and 4.2 in patients with no vs comorbid OA (p=0.013), and mean physician overall global estimates were 3.6 and 4.5, respectively, in the 2 groups (p=0.040). Physician estimates for inflammation and distress did not differ significantly in the 2 groups (Table).

Conclusion: Secondary OA in patients with inflammatory arthritides can be identified and documented on simple MDHAQ and RheuMetric forms in busy clinical settings. This documentation provides evidence of patient clinical complexity and may explain management decisions in certain patients which appear at variance with “treat-to-target” guidelines.

Reference: 1)Tymms K, et al. Arthritis Care Res (Hoboken). 2014;66:190-6.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/identification-and-documentation-of-secondary-osteoarthritis-in-patients-with-primary-inflammatory-arthritides-using-a-patient-mdhaqrapid3-and-a-physician-estimate-of-joint-damage-to-recognize-patien/