Session Information
Date: Sunday, November 8, 2015
Title: Health Services Research Poster I: Diagnosis, Management and Treatment Strategies
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: RA generally is regarded by physicians and the public as a more severe problem than OA. However, OA has been ranked as the 11th highest contributor to global disability among all diseases (1), and costs of OA and RA each have been found to account for about 1% of the US gross domestic product (2), explained in part by the higher prevalence of OA vs RA. Nonetheless, the standardized mortality ratio (SMR) (which is independent of prevalence) for OA is reported as 1.55 (3), and quite similar to the SMR for RA of 1.5-1.6 (4). Therefore, the severity of OA may be underestimated. We compared patient MDHAQ/RAPID3 (multidimensional health assessment questionnaire/routine assessment of patient data 3) and physician global estimates in patients with a primary diagnosis of osteoarthritis (OA) or rheumatoid arthritis (RA) at 4 rheumatology clinical settings.
Methods: Patients were seen in routine care at 4 clinical settings: Liverpool Hospital, New South Wales, Australia, Rush University Medical Center, Chicago, IL, NYU Medical Center, New York, NY, and Arthritis and Rheumatology, a solo private practice, Ridley Park, PA. At each site, patients complete an MDHAQ at each visit in the waiting area while waiting to see the rheumatologist. The MDHAQ includes scores for physical function (0-10), pain (0-10), and patient global estimate (0-10), and RAPID3 composite scores of these 3 RA core data set measures (0-30). The physician assigns a global estimate for each patient (DOCGL). Patients with OA were compared to RA patients at each site for mean or median MDHAQ demographic measures, self-report physical function, pain, patient global estimate, RAPID3, and fatigue scores, as well as physician global estimates.
Results: Median scores for patients with OA were higher than for RA in 11 of 16 comparisons of MDHAQ scores (Table). Median DOCGL was higher in OA at 2 sites. Median physical function scores ranged from 1.7 to 2.7 for RA and 1.7 to 3.3 for OA; pain scores from 4 to 5 for RA and 5 to 7 for OA; patient global estimates from 4 to 5 for RA and 5 to 6 for OA; DOCGL from 0 to 4 for RA and 1 to 5 for OA; RAPID3 scores from 9.7 to 11.8 for RA and 11.7 to 16.8 for OA (Table).
Conclusion: Among treated patients, levels of patient physical function, pain, patient and physician global estimates, and RAPID3 in OA patients are in the same range as in RA patients. The findings likely reflect in part better treatments for RA. However, the severity of OA may be underestimated. Better information concerning OA may lead to improved clinical management and resource allocation for OA.
References: 1) Ann Rheum Dis. 2014;73(7):1323-30. 2) Arthritis Rheum. 1995;38(10):1351-62. 3) BMJ. 2011;342:d1165. 4) Clin Exp Rheumatol. 2008;26(5 Suppl 51):S35-61.
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Table: MDHAQ/RAPID3 and RheuMetric scores for patients with RA and OA in 4 clinical settings: Liverpool, Rush, NYU, and Ridley Park |
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Liverpool Hospital |
Rush Medical Center |
NYU Medical Center |
Ridley Park |
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RA (n=64) |
OA (n=52) |
RA (n=173) |
OA (n=199) |
RA (n=145) |
OA (n= 173) |
RA (n=39) |
OA (n=41) |
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Demographic measures |
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Age, mean (SD) years |
58.7 (14.0) |
66.1 (10.7) |
57.9 (15.9) |
67.2 (12.1) |
49.3 (15.8) |
62.6 (12.4) |
56.8 (13.9) |
67.2 (12.2) |
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Education level |
10 (9-12) |
10 (8-12) |
14 (12-16) |
14 (12-16) |
16 (13-18) |
16 (13-18) |
13.5 (2.2) |
13 (1.7) |
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Female |
79.7 % |
88.4 % |
86.1 % |
85.4 % |
74 % |
78 % |
90% |
67% |
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MDHAQ: Patient self-report scores |
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MDHAQ-FN |
1.7 (0.7-3) |
3.3 (2.3-4.7) |
2.7 (0.7-3.7) |
2.7 (1.3-4) |
1.7 (0.3-3.7) |
1.7 (0.7-3.3) |
1.9 (1.8) |
1.8 (1.7) |
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MDHAQ-PN |
4.3 (2.5-8.3) |
7.0 (5.5-8.3) |
5 (2-7.5) |
7 (5-8.5) |
4.7 (2-7) |
5 (3-7.5) |
3.9 (3.2) |
3.9 (2.8) |
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MDHAQ-PATGL |
4.3 (1.3-6.8) |
6.0 (4.3-8) |
4.5 (1.5-7) |
5.7 (3.5-8) |
5 (1.5-7) |
5 (2-6.5) |
3.4 (3.0) |
4.6 (3.0) |
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RAPID3 |
9.7 (5.5-17) |
16.8 (11.3-19.7) |
11.8 (4.3-18.7) |
15.5 (10.2-19.5) |
11 (4-16.7) |
11.7 (6.7-16.7) |
9.2 (7.6) |
10.3 (6.9) |
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RheuMetric: Physician Estimates |
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DOCGL |
4 (2-5) |
5 (3-6) |
3.7 (2-5) |
4 (3.5-5) |
2.5 (1.5-3.5) |
2.5 (2-3.5) |
3.9 (1.6) |
3.6 (1.9) |
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Values are median and interquartile range unless indicated otherwise |
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To cite this abstract in AMA style:
El-Haddad C, Castrejón I, Gibson KA, Yazici Y, Bergman M, Pincus T. Patients with Osteoarthritis and Rheumatoid Arthritis Seen at 4 Different Routine Rheumatology Care Sites at This Time Have Similar and Patient and Physician Global Estimates of Severity, and Scores for Functional Disability, Pain, and RAPID3 [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/patients-with-osteoarthritis-and-rheumatoid-arthritis-seen-at-4-different-routine-rheumatology-care-sites-at-this-time-have-similar-and-patient-and-physician-global-estimates-of-severity-and-scores-f/. Accessed .ACR Meeting Abstracts - https://acrabstracts.org/abstract/patients-with-osteoarthritis-and-rheumatoid-arthritis-seen-at-4-different-routine-rheumatology-care-sites-at-this-time-have-similar-and-patient-and-physician-global-estimates-of-severity-and-scores-f/