Background/Purpose:

Quantitative measures to assess and monitor patients with rheumatoid arthritis (RA) traditionally have been laboratory tests, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). However, ESR and CRP values have been found to be normal in about 40% of RA patients ^{1, 2}. By contrast, RAPID3 (routine assessment of patient index data) self-report scores are reported elevated in more than 75% of RA patients, and generally are more effective than laboratory tests to distinguish active from control treatment in clinical trials ³. Normal initial measures can document worsening of clinical status, but not improvement, at future visits. We analyzed the proportion of treatment-naïve RA patients at an initial visit to an academic rheumatology setting for elevated or normal values for RAPID3, ESR and CRP.

Methods:

All patients at one academic setting complete a multi-dimensional health assessment questionnaire (MDHAQ), which includes RAPID3 and other scales, at each visit. RAPID3 is an index of the 3 self-report 0-10 measures, physical function, pain, and patient global assessment, compiled into a 0-30 score. A retrospective analysis of RAPID3, ESR, and CRP data at initial visits of RA patients was conducted. RAPID3 scores were classified as remission (≤ 3), low (3.1-6), moderate (6.1-12), and high (≥12) severity ⁴. ESR and CRP were classified according to normal values at the study site laboratory as ESR < or >17 mm/hr in men, < or >27 mm/hr in women, and CRP < or >8 mg/dl. ESR data for men and women were merged. Cross-tabulations were performed to compare patients in 4 RAPID3 categories, according to whether ESR or CRP or both ESR and CRP were normal or abnormal; chi-square tests were used to analyze statistical significance.

Results:

Overall, 105 patients were studied; 78% female, mean (SD) age 54.2 (15), RAPID3 13.9 (7.2), ESR 33.7 (29.9) and CRP 22 .1 (47.9). Among all 105 patients, elevated ESR was seen in 49%, elevated CRP in 44%, both elevated CRP and ESR in 32%, and elevated RAPID3 in 93%, including 82% with moderate, and 65% high severity (Table). Among 86 patients whose RAPID3 indicated moderate or high disease severity, elevated ESR was seen in 38 (44%), elevated CRP in 41 (48%), and both elevated ESR and CRP in 29 (34%). By contrast, 5 of 7 patients with RAPID3 <3 had elevated ESR, and 1 elevated CRP as well as ESR (Table). One limitation of is that comorbidities, which can lead to elevated rapid RAPID3 scores, were not collected systematically.

Conclusion:

At the initial visit of treatment naïve RA patients, RAPID3 was substantially more likely to be elevated than ESR or CRP to monitor disease status and document improvement.

References:

1- J Rheumatol. 2009 Jul;36(7):1387-90

2- J Rheumatol. 1994 Jul;21(7):1227-37

3- Bull Hosp Jt Dis (2013). 2013;71(2):117-20

4- Rheum Dis Clin North Am. 2009 Nov;35(4):773-8

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/rapid3-is-elevated-in-93-of-treatment-naive-rheumatoid-arthritis-ra-patients-at-initial-visit-compared-to-49-for-erythrocyte-sedimentation-rate-esr-and-44-for-c-reactive-protein-crp/