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Gibson KA, Kaplan RM, Pincus T, Li T, Luta G. PROMIS-29 in rheumatoid arthritis patients who screen positive or negative for fibromyalgia on MDHAQ FAST4 (fibromyalgia assessment screening tool) or 2011 fibromyalgia criteria. Semin Arthritis Rheum 2024; 66:152361. [PMID: 38360468 DOI: 10.1016/j.semarthrit.2024.152361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 12/11/2023] [Accepted: 01/03/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND PROMIS-29 T-scores query health-related quality of life (HRQL) in 7 domains, physical function, pain, fatigue, anxiety, depression, sleep quality, and social participation, to establish population norms. An MDHAQ (multidimensional health assessment questionnaire) scores these 7 domains and includes medical information such as a FAST4 (fibromyalgia assessment screening tool) index. We analyzed PROMIS-29 T-scores in rheumatoid arthritis (RA) patients vs population norms and for positive vs negative fibromyalgia (FM) screens and compared PROMIS-29 T-scores to MDHAQ scores to assess HRQL. METHODS A cross-sectional study was performed at one routine visit of 213 RA patients, who completed MDHAQ, PROMIS-29, and reference 2011 FM Criteria. PROMIS-29 T-scores were compared in RA vs population norms and in FM+ vs FM- RA patients, based on MDHAQ/FAST4 and reference criteria. Possible associations between PROMIS-29 T-scores and corresponding MDHAQ scores were analyzed using Spearman correlations and multiple regressions. RESULTS Median PROMIS-29 T-scores indicated clinically and statistically significantly poorer status in 26-29% FM+ vs FM- RA patients, with larger differences than in RA patients vs population norms for 6/7 domains. MDHAQ scores were correlated significantly with each of 7 corresponding PROMIS-29 domains (|rho|≥0.62, p<0.001). Linear regressions explained 55-73% of PROMIS-29 T-score variation by MDHAQ scores and 56%-70% of MDHAQ score variation by PROMIS-29 T-scores. CONCLUSIONS Scores for 7 PROMIS-29 domains and MDHAQ were highly correlated. The MDHAQ is effective to assess HRQL and offers incremental medical information, including FAST4 screening. The results indicate the importance of assessing comorbidities such as fibromyalgia screening in interpreting PROMIS-29 T-scores.
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Affiliation(s)
- Kathryn A Gibson
- Department of Rheumatology, Liverpool Hospital, Ingham Research Institute, University of New South Wales, Sydney, NSW, 2170, Australia
| | - Robert M Kaplan
- Clinical Excellence Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94305
| | - Theodore Pincus
- Division of Rheumatology, Department of Internal Medicine, Rush University School of Medicine, Chicago, Ill, 60612, USA.
| | - Tengfei Li
- Department of Biostatistics, Bioinformatics & Biomathematics, Georgetown University, Washington, DC, 20057, USA
| | - George Luta
- Department of Biostatistics, Bioinformatics & Biomathematics, Georgetown University, Washington, DC, 20057, USA; Clinical Research Unit, The Parker Institute, Copenhagen University Hospital, Frederiksberg, DK-2000, Denmark
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Schmukler J, Li T, Pincus T. Physician estimate of inflammation vs global assessment in explaining variations in swollen joint counts in rheumatoid arthritis patients. Rheumatol Adv Pract 2024; 8:rkae057. [PMID: 38800575 PMCID: PMC11116827 DOI: 10.1093/rap/rkae057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/16/2024] [Indexed: 05/29/2024] Open
Abstract
Objective To analyse patients with RA for inflammatory activity by physician estimate of global assessment (DOCGL) vs an estimate of inflammatory activity (DOCINF) to explain variation in the swollen joint count (SJC). Methods Patients with RA were studied at routine care visits. Patients completed a multidimensional health assessment questionnaire (MDHAQ) and the physician completed a 28-joint count for swollen (SJC), tender (TJC) and deformed (DJC) joints and a RheuMetric checklist with a 0-10 DOCGL visual numeric scale (VNS) and 0-10 VNS estimates of inflammation (DOCINF), damage (DOCDAM) and patient distress (DOCSTR). The disease activity score in 28 joints with ESR (DAS28-ESR), Clinical Disease Activity Index (CDAI) and Routine Assessment of Patient Index Data 3 (RAPID3) were calculated. Individual scores and RA indices were compared according to Spearman correlation coefficients and regression analyses. Results A total of 104 unselected patients were included, with a median age and disease duration of 54.5 and 5 years, respectively. The median DAS28-ESR was 2.9 (Q1-Q3: 2.0-3.7), indicating low activity. DOCINF was correlated significantly with DOCGL (ρ = 0.775). Both DOCGL and DOCINF were correlated significantly with most other measures; correlations with DOCGL were generally higher than with DOCINF other than for SJC. In regression analyses, DOCINF was more explanatory of variation in SJC than DOCGL and other DAS28-ESR components. Conclusions Variation in SJC is explained more by a 0-10 DOCINF VNS than the traditional DOCGL or any other measure in RA patients seen in routine care. DOCINF on a RheuMetric checklist can provide informative quantitative scores concerning inflammatory activity in RA patients monitored over long periods.
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Affiliation(s)
- Juan Schmukler
- Division of Rheumatology, Department of Medicine, Rush University School of Medicine, Chicago, IL, USA
| | - Tengfei Li
- Division of Rheumatology, Department of Medicine, Rush University School of Medicine, Chicago, IL, USA
| | - Theodore Pincus
- Division of Rheumatology, Department of Medicine, Rush University School of Medicine, Chicago, IL, USA
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Germain G, Worley K, MacKnight SD, Rubin B, Bell CF, Laliberté F, Urosevic A, Sheng Duh M, Concoff A. Evaluating the real-world effectiveness of belimumab in patients with SLE using SLE-related laboratory values and rheumatoid arthritis-derived disease activity measures: RAPID3, swollen joint count and tender joint count. Lupus Sci Med 2024; 11:e001111. [PMID: 38575172 PMCID: PMC11002435 DOI: 10.1136/lupus-2023-001111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/04/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE To investigate the real-world impact of intravenous belimumab treatment among patients with SLE using rheumatoid arthritis-derived disease activity measures and SLE-related laboratory values. METHODS This retrospective cohort study used US electronic medical record data from the United Rheumatology Normalised Integrated Community Evidence (UR-NICE) database. Adult patients with SLE who initiated intravenous belimumab between 1 January 2012 and 3 December 2019 (index), had 12 months of pre-index and 24 months of post-index clinical activity, and had ≥6 infusions of belimumab during the 24 months post-index were included. The primary outcome measure was time to first improvement of minimally important difference (MID) for Routine Assessment of Patient Index Data 3 (RAPID3), Patient Pain Index (PPI), swollen joint count, tender joint count (TJC), complement C3 and C4 and anti-double-stranded DNA antibodies during the on-treatment follow-up period of up to 24 months. The secondary outcome measure evaluated the trajectories of these outcome measures for up to 24 months of belimumab treatment. RESULTS Of 495 patients included, between 21.0% and 52.1% had ≥1 record for each of the disease activity measures or laboratory values in the pre-index and post-index periods and were included in analyses for that measure. The proportion of patients achieving MID for each measure increased rapidly within 3 months, with continued gradual improvement throughout the remaining on-treatment period, up to 24 months. After 6 months, 52.3% and 55.3% of patients had achieved MID in RAPID3 and PPI, respectively. Outcome measure trajectories indicated improved disease activity with belimumab treatment, particularly in RAPID3, TJC and laboratory values. CONCLUSIONS In this real-world effectiveness study, belimumab therapy for SLE resulted in clinically meaningful improvements in rheumatoid arthritis-derived disease activity measures within 3 months of treatment, with patients who remained on belimumab therapy experiencing improvement even up to 24 months of observation.
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Affiliation(s)
| | - Karen Worley
- Value, Evidence & Outcomes, GSK Collegeville, Collegeville, Pennsylvania, USA
| | | | - Bernard Rubin
- US Medical Affairs and Immuno-inflammation, GSK, Durham, North Carolina, USA
| | | | | | - Ana Urosevic
- Groupe d'analyse, Ltée, Montreal, Quebec, Canada
| | | | - Andrew Concoff
- Hauppauge, NY and Exagen, United Rheumatology, Vista, California, USA
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Naylor JM, Gibson K, Mills K, Schabrun SM, Livings R, Dennis S, Thom J. A snapshot of primary care physiotherapy management of knee osteoarthritis in an Australian setting: does it align with evidence-based guidelines? Physiother Theory Pract 2024; 40:347-356. [PMID: 36036385 DOI: 10.1080/09593985.2022.2114816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 08/06/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Systematic implementation of evidence-based, clinical practice guidelines for management of knee osteoarthritis (OA) in primary care physiotherapy in Australia is embryonic. Clinical practice guidelines have been implemented in the public healthcare sector at a State-level for physiotherapists in the form of multidisciplinary programs, but the reach of physiotherapy-led OA management programs is grossly inadequate in the private sector. OBJECTIVE To provide a snapshot of the management of people with knee OA in private physiotherapy practice in an Australian setting. Primarily the aim was to determine the alignment between the treatment provided and guideline-based management. Secondary aims included the capture of both patient-reported improvement after 3-months and patient satisfaction with treatment. Whether patient-reported outcome measures (PROMS) were routinely used was also ascertained. METHODS A prospective, observational study enrolling adults >=45 years with knee OA across nine primary care physiotherapy practices. Knee injury OA Outcome Score (KOOS) and Routine Assessment Patient Index 3 (RAPID3) were collected (baseline; 3 months) by researchers along with satisfaction with treatment. Treatment details and use of PROMS were obtained from physiotherapy record audit and patient interview. The treatment provided was compared to the minimum core elements of management stipulated in OA management guidelines. RESULTS Twenty-six adults (58% female, mean age 60 (9) years, 54% overweight or obese) participated. 100% were prescribed ≥1 appropriate exercise(s); 42% received OA education; 12% received weight management advice. Mean improvement (95%CI) in KOOS Pain was 9.8 (3.4 to 16.1) and RAPID3 was -3.4 (-5.5 to -1.3). Satisfaction with treatment was high (8.3/10). No PROMs were used for assessment or monitoring. CONCLUSION Primary care physiotherapy treatment of knee OA did not meet minimum criteria per clinical practice guidelines. However, participant improvement at three months reached minimally important change thresholds for patient-reported measures and satisfaction was high. The data provide useful insights about areas that are deficient, thus, should inform future implementation strategies designed to improve care delivery and the uptake of routine measurement of patient-reported outcomes.
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Affiliation(s)
- Justine M Naylor
- Orthopaedic Department, Liverpool Hospital, Liverpool, Australia
| | - Kathryn Gibson
- Orthopaedic Department, Liverpool Hospital, Liverpool, Australia
| | - Kat Mills
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Australia
| | - Siobhan M Schabrun
- Gray Center for Mobility and Activity, Parkwood Institute, London, ON, Canada
- School of Physical Therapy, University of Western Ontario, London, ON, Canada
- Centre for Pain, Neuroscience Research Australia, Randwick, Australia
| | - Rebecca Livings
- Centre for Pain, Neuroscience Research Australia, Randwick, Australia
| | - Sarah Dennis
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
- Allied Health, Injury and Rehabilitation Stream, Ingham Institute of Applied Medical Research, Liverpool, Australia
| | - Jeanette Thom
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
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Islam ST, Descallar J, Martens D, Hassett G, Gibson KA. Screening for Anxiety in Patients With Inflammatory Arthritis Using the Multidimensional Health Assessment Questionnaire. J Rheumatol 2023; 50:1273-1278. [PMID: 37399467 DOI: 10.3899/jrheum.2022-1261] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE To analyze the Multidimensional Health Assessment Questionnaire (MDHAQ) in screening for anxiety in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA), compared to the Hospital Anxiety and Depression Scale (HADS) as the reference standard. METHODS Patients with a physician diagnosis of RA or PsA were invited to complete the MDHAQ and HADS at their routine rheumatology clinic visit. Sensitivity, specificity, percent agreement, and [Formula: see text] statistics were used to evaluate agreement between 2 MDHAQ items for anxiety and HADS subscale for Anxiety (HADS-A) score of ≥ 8. The first item is a question asked on a 4-point scale (0-3.3), and the second is a yes or no (blank) question asked within a 60-item review of symptoms (ROS) checklist. RESULTS The study included 183 participants, of whom 126 (68.9%) had RA and 57 (31.1%) had PsA. The mean age was 57.3 years and 66.7% were female. Positive screening for anxiety according to a HADS-A score of ≥ 8 was seen in 39.3% of patients. Compared to those with a HADS-A score of ≥ 8, patients with an MDHAQ score of ≥ 2.2 or a positive on ROS had a sensitivity of 69.9%, specificity of 73.6% and substantial agreement (agreement 80.9%, [Formula: see text] 0.59). CONCLUSION The MDHAQ provides information similar to the HADS in screening for anxiety in patients with RA and PsA. The use of this single questionnaire, which can also be used to monitor clinical status and to screen for fibromyalgia and depression without requiring multiple questionnaires, may prove a valuable tool in routine clinical practice.
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Affiliation(s)
- Sadia Tasnim Islam
- S.T. Islam, MD, Department of Rheumatology, Liverpool Hospital, Liverpool;
| | - Joseph Descallar
- J. Descallar, MBiostat, Ingham Institute for Applied Medical Research, Liverpool, and South West Sydney Clinical Campuses, School of Clinical Medicine, University of New South Wales (UNSW Sydney), Liverpool
| | - David Martens
- D. Martens, MBBS, Department of Rheumatology, Liverpool Hospital, Liverpool, and South West Sydney Clinical Campuses, School of Clinical Medicine, UNSW Sydney, Liverpool
| | - Geraldine Hassett
- G. Hassett, PhD, K.A. Gibson, PhD, Department of Rheumatology, Liverpool Hospital, Liverpool, Ingham Institute for Applied Medical Research, Liverpool, and South West Sydney Clinical Campuses, School of Clinical Medicine, UNSW Sydney, Liverpool, Australia
| | - Kathryn Alleyne Gibson
- G. Hassett, PhD, K.A. Gibson, PhD, Department of Rheumatology, Liverpool Hospital, Liverpool, Ingham Institute for Applied Medical Research, Liverpool, and South West Sydney Clinical Campuses, School of Clinical Medicine, UNSW Sydney, Liverpool, Australia
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Rodwell N, Hassett G, Bird P, Pincus T, Descallar J, Gibson KA. RheuMetric Quantitative 0 to 10 Physician Estimates of Inflammation, Damage, and Distress in Rheumatoid Arthritis: Validation Against Reference Measures. ACR Open Rheumatol 2023; 5:511-521. [PMID: 37608509 PMCID: PMC10570671 DOI: 10.1002/acr2.11574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/23/2023] [Accepted: 04/26/2023] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVE To analyze a RheuMetric checklist, which includes four feasible physician 0 to 10 scores for DOCGL, inflammation (DOCINF), damage (DOCDAM), and distress (DOCSTR) for criterion and discriminant validity against standard reference measures. METHODS A prospective, cross-sectional assessment was performed at one routine care visit at Liverpool Hospital, Sydney, Australia. Rheumatologists recorded DOCGL, DOCINF, DOCDAM, DOCSTR, and 28 joint counts for swelling (SJC), tenderness (TJC), and limited motion/deformity (DJC). Patients completed a multidimensional health assessment questionnaire (MDHAQ), which includes routine assessment of patient index data (RAPID3), fibromyalgia assessment screening tool (FAST4), and MDHAQ depression screen (MDS2). Laboratory tests and radiographic scores were recorded. RheuMetric estimates of inflammation, damage, and distress were compared with reference and other measures using correlations and linear regressions. RESULTS In 173 patients with RA, variation in RheuMetric DOCINF was explained significantly by SJC and inversely by disease duration; variation in DOCDAM was explained significantly by DJC, radiographic scores, and physical function; and variation in DOCSTR was explained significantly by fibromyalgia and depression. CONCLUSION RheuMetric DOCINF, DOCDAM, and DOCSTR estimates were correlated significantly and specifically with reference measures of inflammation, damage, and distress, documenting criterion and discriminant validity.
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Affiliation(s)
- Nicholas Rodwell
- Liverpool Hospital and Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia, and University of New South WalesMedicine and HealthSydneyNew South WalesAustralia
| | - Geraldine Hassett
- Liverpool Hospital and Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia, and University of New South WalesMedicine and HealthSydneyNew South WalesAustralia
| | - Paul Bird
- University of New South Wales, Medicine and HealthKensingtonSydneyNew South WalesAustralia
| | | | - Joseph Descallar
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia, and University of New South WalesMedicine and HealthSydneyNew South WalesAustralia
| | - Kathryn A. Gibson
- Liverpool Hospital and Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia, and University of New South WalesMedicine and HealthSydneyNew South WalesAustralia
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Schmukler J, Li T, Gibson KA, Morla RM, Luta G, Pincus T. Patient global assessment is elevated by up to 5 of 10 units in patients with inflammatory arthritis who screen positive for fibromyalgia (by FAST4) and/or depression (by MDS2) on a single MDHAQ. Semin Arthritis Rheum 2023; 58:152151. [PMID: 36586208 DOI: 10.1016/j.semarthrit.2022.152151] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 12/01/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patient global assessment (PATGL) is a component of rheumatoid arthritis (RA) and spondyloarthritis (SpA) activity indices, reflecting inflammation in selected clinical trial patients. In routine care, PATGL often may be elevated independently of inflammatory activity by fibromyalgia (FM) and/or depression, leading to complexities in interpretation. A feasible method to screen for FM and/or depression could help to clarify interpretation of high PATGL and index scores, including explanation of apparent limited responses to anti-inflammatory therapies. PATIENTS AND METHODS Patients with RA or SpA in routine care in Barcelona, Chicago, and Sydney complete a 2-page multidimensional health assessment questionnaire (MDHAQ) in 5-10 min. The MDHAQ includes PATGL and three indices, RAPID3 (routine assessment of patient index data) to assess clinical status, FAST4 (0-4 fibromyalgia assessment screening tool) and MDS2 (0-2 MDHAQ depression screen). PATGL was compared for each diagnosis at each site and pooled data in FAST4 positive (+) vs negative (-) and/or MDS2+ vs MDS2- patients using medians and median regressions. RESULTS Median PATGL was 5.0 in 393 RA and 175 SpA patients; 2.0-3.0 in 305 (58.9%) FAST4-,MDS2- patients, 5.5-6.0 in 71 (13.7%) FAST4-,MDS2+ patients, 7.0-7.5 in 50 (9.7%) FAST4+,MDS2- patients, and 7.0-8.0 in 92 (17.8%) FAST4+,MDS2+ patients. Positive FAST4 and/or MDS2 screens were seen in 41% of patients. Results were similar in RA and SpA at 3 settings on 3 continents. CONCLUSION Median 0-10 PATGL varied from 2-3/10 to 5.5-8/10, according to negative vs positive screening for FM and/or depression on a single MDHAQ for busy clinical settings.
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Affiliation(s)
- Juan Schmukler
- Division of Rheumatology, Department of Medicine, Rush University School of Medicine, Chicago, IL 60612, United States
| | - Tengfei Li
- Department of Biostatistics, Bioinformatics & Biomathematics, Georgetown University, Washington, DC 20057, United States
| | - Kathryn A Gibson
- Department of Rheumatology, Liverpool Hospital, Ingham Research Institute, University of New South Wales, Sydney, NSW 2170, Australia
| | - Rosa M Morla
- Department of Rheumatology, Hospital Clinic Universitari de Barcelona, Institut d´investigacions Biomèdiques August Pi i Sunyer, 08036 Barcelona, Spain
| | - George Luta
- Department of Biostatistics, Bioinformatics & Biomathematics, Georgetown University, Washington, DC 20057, United States
| | - Theodore Pincus
- Division of Rheumatology, Department of Medicine, Rush University School of Medicine, Chicago, IL 60612, United States.
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Martínez-Gonzáles PL, Chico Capote A, Estévez Del Toro M, Hidalgo Costa T. Educational needs in patients with knee osteoarthritis using the SpENAT questionnaire. REUMATOLOGIA CLINICA 2022; 18:603-607. [PMID: 35484071 DOI: 10.1016/j.reumae.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/02/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Knee osteoarthritis (KOA) is a major public health issue because it causes pain and functional limitation in patients. Engagement with self-management may, however, minimize the impact of KOA on the health of patients suffering this illness. To be fully engaged with self-management activities, knowledge about KOA is a prerequisite. There is data on people's understanding of KOA and their needs for information about KOA. The Educational Needs Assessment Tool-Spanish version (SpENAT) is a self-reported questionnaire that assesses educational needs (Ned) in order to provide information adapted and focused on patients with knee KOA. It comprises 39 questions grouped into seven domains: Pain, Movement, Feelings, Osteoarthritis, Medical treatment, Non-medical treatment, Help. OBJECTIVES To estimate the Ned in patients with knee KOA using the SpENAT. MATERIAL AND METHOD An observational, descriptive, and cross-sectional study was carried out in 215 patients with a diagnosis of knee KOA according to the criteria of the American College of Rheumatology who attended the service's protocolized consultation of knee conditions of rheumatology at the "Hermanos Ameijeiras" Surgical Clinical Hospital during the study period between January 2017 and August 2020. Demographic data, educational level and characteristics of the disease were recorded. All patients completed the SpENAT and were questioned about the sources they turn to obtain information on their disease. RESULTS Women over 50 years of age and overweight with a diagnosis of OA predominated. Major Ned were observed in the domains of movement, help, pain, feeling, KOA. Patients over 50 years of age, female, normal weight, and active workers showed greater interest in the movement domain. The most used source of information was the rheumatologist (91.60%). CONCLUSION The Ned in patients with knee KOA are high, and are higher in the domains of movement, pain, help and feeling. The rheumatologist is the main source of information for patients with KOA, it seems wise to design a targeted strategy to educate people about KOA to provide, support and prepare them for self-management.
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Affiliation(s)
| | - Araceli Chico Capote
- Servicio de Reumatología, Hospital Docente Clínico-Quirúrgico Hermanos Ameijeiras, La Habana, Cuba
| | - Miguel Estévez Del Toro
- Servicio de Reumatología, Hospital Docente Clínico-Quirúrgico Hermanos Ameijeiras, La Habana, Cuba
| | - Tania Hidalgo Costa
- Servicio de Bioestadística, Hospital Docente Clínico-Quirúrgico Hermanos Ameijeiras, La Habana, Cuba
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Ward L, Oliffe M, Kane B, Chessman D, Meaney D, Briggs F, Gibson K, Barnsley L, Sumpton D. Correlation of patient-reported routine assessment of patient index data with clinical measures of disease activity in psoriatic arthritis. Int J Rheum Dis 2022; 25:584-591. [PMID: 35338576 PMCID: PMC9310573 DOI: 10.1111/1756-185x.14310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/27/2022] [Accepted: 02/14/2022] [Indexed: 11/27/2022]
Abstract
Aim A treat‐to‐target strategy is recommended for management of psoriatic arthritis (PsA), although there is lack of agreement regarding the best measure of disease activity to target. Physician assessments included in traditional indices can be complex and time consuming to complete and cannot be readily conducted by telehealth. This study compares the routine assessment of patient index data 3 (RAPID3), an efficient tool comprising patient self‐assessment, with traditional clinician‐led composite measures in the PsA clinic setting. Methods Data were collected prospectively from July 2016 to March 2020 in 2 dedicated PsA clinics in Sydney, Australia. A receiver operating characteristic (ROC) curve was created for comparison of RAPID3 score with composite scores minimal disease activity (MDA), very low disease activity (VLDA) and disease activity in psoriatic arthritis (DAPSA) in low disease activity or remission. Results Ninety‐three patients had simultaneous collection of RAPID3 and MDA measures. Mean (SD) age was 49.9 (13.5) years, 50.5% were male and 23 (24.7%) had erosive disease at baseline. RAPID3 scores ≤3.2 and ≤2.7 (range 0‐30) had high sensitivity and specificity for VLDA and DAPSA remission respectively, with ROC curve area under the curve (95% CI) of 0.94 (0.91‐0.97) and 0.96 (0.93‐0.99). Conclusion RAPID3 has good agreement with physician‐led composite scores of MDA, VLDA and DAPSA, and provides a viable alternative to composite scores. This is particularly helpful in settings that do not allow for clinical examination, for example telehealth.
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Affiliation(s)
- Louise Ward
- Rheumatology Department, Concord Hospital, Sydney, New South Wales, Australia
| | - Michael Oliffe
- Rheumatology Department, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Barry Kane
- Rheumatology Department, Concord Hospital, Sydney, New South Wales, Australia
| | - Diana Chessman
- Rheumatology Department, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Donna Meaney
- Rheumatology Department, Concord Hospital, Sydney, New South Wales, Australia
| | - Fiona Briggs
- Rheumatology Department, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Kathryn Gibson
- Rheumatology Department, Liverpool Hospital, Liverpool, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Les Barnsley
- Rheumatology Department, Concord Hospital, Sydney, New South Wales, Australia.,Concord Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Daniel Sumpton
- Rheumatology Department, Concord Hospital, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital Westmead, University of Sydney, Sydney, New South Wales, Australia
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Pickles T, Macefield R, Aiyegbusi OL, Beecher C, Horton M, Christensen KB, Phillips R, Gillespie D, Choy E. Patient Reported Outcome Measures for Rheumatoid Arthritis Disease Activity: a systematic review following COSMIN guidelines. RMD Open 2022; 8:e002093. [PMID: 35351807 PMCID: PMC8966547 DOI: 10.1136/rmdopen-2021-002093] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/03/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The current standard of care in rheumatoid arthritis (RA) requires regular assessment of disease activity (DA). All standard RA DA measurement instruments require joint counts to be undertaken by a healthcare professional with/without a blood test. Few healthcare providers have the capacity to assess patients as frequently as stipulated by guidelines. Patient Reported Outcome Measures (PROMs) could be an efficient and informative way to assess RA DA, which is highlighted by the SARS-COV-2 pandemic, as most consultations are remote rather than face-to-face. We aimed to assess all PROMs for RA DA against the internationally recognised COSMIN guidelines to provide evidence-based recommendations to select the most suitable PROMs. METHODS Review registered on PROSPERO as CRD42020176176. The search strategy was based on a previous similar systematic review and expanded to include all articles up to January 2019. All identified articles were rated by two independent assessors following the COSMIN guidelines. RESULTS 668 abstracts were identified, with 10 articles included. A further 21 were identified from a previous review. Ten PROMs were identified. There was insufficient evidence to place any of the identified PROMs into recommendation for use category A due to lack of evidence for content validity, as stipulated by the COSMIN guidelines. CONCLUSION Lack of evidence of content validity limits suitable PROM selection, therefore none can be recommended for use. It is acknowledged that all included PROMs were developed before the COSMIN guidelines were published. Future research on PROMs for RA DA must provide evidence of content validity.
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Affiliation(s)
- Tim Pickles
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Rhiannon Macefield
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Olalekan Lee Aiyegbusi
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Applied Research Collaboration West Midlands, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Brmingham, UK
- NIHR Birmingham Biomedical Research Centre, NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
| | - Claire Beecher
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
- Evidence Synthesis Ireland and Cochrane Ireland, National University of Ireland Galway, Galway, Ireland
- Health Research Board - Trials Methodology Research Network, National University of Ireland, Galway, Ireland
| | - Mike Horton
- Psychometric Laboratory for Health Sciences, University of Leeds, Leeds, UK
| | | | - Rhiannon Phillips
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | | | - Ernest Choy
- Department of Infection and Immunity, Cardiff University, Cardiff, UK
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11
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Nguyen MH, Huang FF, O’Neill SG. Patient-Reported Outcomes for Quality of Life in SLE: Essential in Clinical Trials and Ready for Routine Care. J Clin Med 2021; 10:jcm10163754. [PMID: 34442047 PMCID: PMC8396817 DOI: 10.3390/jcm10163754] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/17/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022] Open
Abstract
Patient-reported outcome (PRO) instruments are widely used to assess quality of life in Systemic Lupus Erythematosus (SLE) research, and there is growing evidence for their use in clinical care. In this review, we evaluate the current evidence for their use in assessing quality of life in SLE in both research and clinical settings and examine the different characteristics of the commonly used PRO tools. There are now several well-validated generic and SLE-specific tools that have demonstrated utility in clinical trials and several tools that complement activity and damage measures in the clinical setting. PRO tools may help overcome physician–patient discordance in SLE and are valuable in the assessment of fibromyalgia and type 2 symptoms such as widespread pain and fatigue. Future work will identify optimal PRO tools for different settings but, despite current limitations, they are ready to be incorporated into patient care.
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Affiliation(s)
- Matthew H. Nguyen
- Liverpool Hospital, Liverpool, NSW 2170, Australia;
- Pathology Department, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Kensington, NSW 2052, Australia
| | - Frank F. Huang
- Rheumatology Department, Royal North Shore Hospital, St Leonards, NSW 2065, Australia;
| | - Sean G. O’Neill
- Rheumatology Department, Royal North Shore Hospital, St Leonards, NSW 2065, Australia;
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, St Leonards, NSW 2065, Australia
- Correspondence: ; Tel.: +61-02-94631890
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12
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Gibson KA, Pincus T. A Self-Report Multidimensional Health Assessment Questionnaire (MDHAQ) for Face-To-Face or Telemedicine Encounters to Assess Clinical Severity (RAPID3) and Screen for Fibromyalgia (FAST) and Depression (DEP). CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2021. [DOI: 10.1007/s40674-021-00175-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Abstract
Purpose of Review
To update the clinical value of a patient self-report multidimensional health assessment questionnaire (MDHAQ).
Recent Findings
The MDHAQ includes 10 individual quantitative scores for physical function, pain, patient global assessment, fatigue, sleep, anxiety, depression, morning stiffness, change in status, and exercise status, and 5 indices, RAPID3 (routine assessment of patient index data) to assess clinical status in all diseases studied, FAST3 (fibromyalgia assessment screening tool) and MDHAQ-Dep (depression) to screen for fibromyalgia and/or depression, RADAI self-report of specific painful joints and joint count, and a symptom checklist for review of systems, and recognition of flares and medication adverse events. The MDHAQ also uniquely queries traditional “medical” information concerning comorbidities, falls, trauma, new symptoms, illnesses, surgeries, hospitalizations, emergencies, medication changes, and medication side effects. Three MDHAQ versions include long for new patients, short for new and return patients, and telemedicine. An electronic MDHAQ (eMDHAQ) has been developed with software that can interface with any electronic medical record (EMR) through the HL7 FHIR standard. However, EMR collaboration and implementation have proven difficult.
Summary
An MDHAQ provides a quantitative overview of patient status with far more information and documentation than an interview, involving minimal extra work for the physician.
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Molina Collada J, Trives L, Castrejón I. The Importance of Outcome Measures in the Management of Inflammatory Rheumatic Diseases. Open Access Rheumatol 2021; 13:191-200. [PMID: 34285602 PMCID: PMC8285275 DOI: 10.2147/oarrr.s276980] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/24/2021] [Indexed: 11/23/2022] Open
Abstract
Rheumatic inflammatory diseases include a diverse and heterogeneous group of multifaceted disorders in which clinical history and physical examination are essential to make treatment choices and for optimizing outcomes. Composite outcome measures have become very relevant in rheumatology to evaluate disease activity as they capture the most important dimensions of the disease into one single measure. Most outcome measures may include disease manifestations, laboratory data, physician examination as well as the patient perspective as different outcome dimensions of the disease into a simple index. These outcome measures have proved their utility for guiding treatment in treat-to- target strategies and personalized medicine, with remission being the ultimate goal. In this narrative review, we go over the most commonly used outcome measures in rheumatoid arthritis, spondyloarthropathies, including psoriatic arthritis, and systemic lupus erythematosus to provide a practical summary for clinicians for everyday routine care.
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Affiliation(s)
- Juan Molina Collada
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Laura Trives
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Isabel Castrejón
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
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14
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Johnson TM, Michaud K, England BR. Measures of Rheumatoid Arthritis Disease Activity. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:4-26. [PMID: 33091244 DOI: 10.1002/acr.24336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/22/2020] [Indexed: 02/02/2023]
Affiliation(s)
- Tate M Johnson
- US Department of Veterans Affairs Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, and FORWARD, The National Databank for Rheumatic Diseases, Wichita, Kansas
| | - Bryant R England
- US Department of Veterans Affairs Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
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15
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Walsh JA, Wan MT, Willinger C, Husni ME, Scher JU, Reddy SM, Ogdie A. Measuring Outcomes in Psoriatic Arthritis: Comparing Routine Assessment of Patient Index Data and Psoriatic Arthritis Impact of Disease. J Rheumatol 2020; 47:1496-1505. [PMID: 31575704 PMCID: PMC11110026 DOI: 10.3899/jrheum.190219] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To examine the construct validity of Routine Assessment of Patient Index Data 3 (RAPID3) and Psoriatic Arthritis Impact of Disease (PsAID) in patients with psoriatic arthritis (PsA). In examining construct validity, we also addressed scores among subgroups with severe psoriasis, poly articular disease, enthesitis, and dactylitis, and evaluated influences of sociodemographic factors and comorbidities (contextual factors) on these patient-reported outcomes (PRO). METHODS Patients with PsA were enrolled in the Psoriatic Arthritis Research Consortium (PARC) between 2014 and 2016. PARC is a longitudinal observational cohort study conducted at 4 US institutions. In this cross-sectional study, construct validity was assessed by examining Spearman correlation coefficients for RAPID3 and PsAID with physician-reported disease activity measures and other PRO [e.g., Medical Outcomes Study Short Form-12 physical component summary/mental component summary (SF-12 PCS/MCS), Functional Assessment of Chronic Illness Therapy-Fatigue scale (FACIT-F)]. Contextual factors and disease subgroups were assessed in multivariable linear regression models with RAPID3 or PsAID12 as outcomes of interest and the hypothesized contextual factors as covariates. RESULTS Among 401 patients enrolled in PARC, 347 completed RAPID3 or PsAID12. Of these, most were white females with a mean age of 51.7 years (SD 14.02). RAPID3 and PsAID were highly correlated (r = 0.90). These measures were also correlated with the SF-12 PCS (r = -0.67) and FACIT-F (r = -0.77). Important contextual factors and disease subgroups included enthesitis, joint counts, education, insurance type, and depression. CONCLUSION RAPID3 and PsAID12 have excellent construct validity in PsA and are strongly correlated despite differing items. Contextual factors (i.e., the presence of depression and obesity) should be considered when interpreting raw scores of the RAPID3 and PsAID12.
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Affiliation(s)
- Jessica A Walsh
- J.A. Walsh, MD, MBA, A. Ogdie, MD, MSCE, Division of Rheumatology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Marilyn T Wan
- M.T. Wan, MBChB, MPH, Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | | | | | - Jose U Scher
- J.U. Scher, MD, S.M. Reddy MD, New York University School of Medicine, New York, New York, USA
| | - Soumya M Reddy
- J.U. Scher, MD, S.M. Reddy MD, New York University School of Medicine, New York, New York, USA
| | - Alexis Ogdie
- J.A. Walsh, MD, MBA, A. Ogdie, MD, MSCE, Division of Rheumatology, University of Pennsylvania Perelman School of Medicine, Philadelphia;
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16
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Pincus T, Castrejon I, Riad M, Obreja E, Lewis C, Krogh NS. Reliability, Feasibility, and Patient Acceptance of an Electronic Version of a Multidimensional Health Assessment Questionnaire for Routine Rheumatology Care: Validation and Patient Preference Study. JMIR Form Res 2020; 4:e15815. [PMID: 32459182 PMCID: PMC7287716 DOI: 10.2196/15815] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 12/20/2019] [Accepted: 03/29/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND A multidimensional health assessment questionnaire (MDHAQ) that was developed primarily for routine rheumatology care has advanced clinical research concerning disease burden, disability, and mortality in rheumatic diseases. Routine Assessment of Patient Index Data 3 (RAPID3), an index within the MDHAQ, is the most widely used index to assess rheumatoid arthritis (RA) in clinical care in the United States, and it recognizes clinical status changes in all studied rheumatic diseases. MDHAQ physical function scores are far more significant in the prognosis of premature RA mortality than laboratory or imaging data. However, electronic medical records (EMRs) generally do not include patient questionnaires. An electronic MDHAQ (eMDHAQ), linked by fast healthcare interoperability resources (FIHR) to an EMR, can facilitate clinical and research advances. OBJECTIVE This study analyzed the reliability, feasibility, and patient acceptance of an eMDHAQ. METHODS Since 2006, all Rush University Medical Center rheumatology patients with all diagnoses have been asked to complete a paper MDHAQ at each routine care encounter. In April 2019, patients were invited to complete an eMDHAQ at the conclusion of the encounter. Analyses were conducted to determine the reliability of eMDHAQ versus paper MDHAQ scores, arithmetically and by intraclass correlation coefficient (ICC). The feasibility of the eMDHAQ was analyzed based on the time for patient completion. The patient preference for the electronic or paper version was analyzed through a patient paper questionnaire. RESULTS The 98 study patients were a typical routine rheumatology patient group. Seven paper versus eMDHAQ scores were within 2%, differences neither clinically nor statistically significant. ICCs of 0.86-0.98 also indicated good to excellent reliability. Mean eMDHAQ completion time was a feasible 8.2 minutes. The eMDHAQ was preferred by 72% of patients; preferences were similar according to age and educational level. CONCLUSIONS The results on a paper MDHAQ versus eMDHAQ were similar. Most patients preferred an eMDHAQ.
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Affiliation(s)
| | - Isabel Castrejon
- Rush University Medical Center, Chicago, IL, United States.,Department of Rheumatology, General University Hospital Gregorio Marañón, Madrid, Spain
| | - Mariam Riad
- Rush University Medical Center, Chicago, IL, United States
| | - Elena Obreja
- Rush University Medical Center, Chicago, IL, United States
| | - Candice Lewis
- Rush University Medical Center, Chicago, IL, United States
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17
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18
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Gibson KA, Castrejon I, Descallar J, Pincus T. Fibromyalgia Assessment Screening Tool: Clues to Fibromyalgia on a Multidimensional Health Assessment Questionnaire for Routine Care. J Rheumatol 2019; 47:761-769. [PMID: 31474596 DOI: 10.3899/jrheum.190277] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To develop feasible indices as clues to comorbid fibromyalgia (FM) in routine care of patients with various rheumatic diseases based only on self-report multidimensional Health Assessment Questionnaire (MDHAQ) scores, which are informative in all rheumatic diagnoses studied. METHODS All patients with all diagnoses complete an MDHAQ at each visit; the 2011 FM criteria questionnaire was added to the standard MDHAQ between February 2013 and August 2016. The proportion of patients who met 2011 FM criteria or had a clinical diagnosis of FM was calculated. Individual candidate MDHAQ measures were compared to 2011 FM criteria using receiver-operating characteristic (ROC) curves; cutpoints to recognize FM were selected from the area under the curve (AUC) for optimal tradeoff between sensitivity and specificity. Cumulative indices of 3 or 4 MDHAQ measures were analyzed as fibromyalgia assessment screening tools (FAST). RESULTS In 148 patients, the highest AUC in ROC analyses versus 2011 FM criteria were seen for MDHAQ symptom checklist, self-report painful joint count, pain visual analog scale (VAS), and fatigue VAS. The optimal cutpoints were ≥ 16/60 for symptom checklist, ≥ 16/48 for self-report painful joint count, and ≥ 6/10 for both pain and fatigue VAS. Cumulative FAST indices of 2/3 or 3/4 MDHAQ measures correctly classified 89.4-91.7% of patients who met 2011 FM criteria. CONCLUSION FAST3 and FAST4 cumulative indices from only MDHAQ scores correctly identify most patients who meet 2011 FM criteria. FAST indices can assist clinicians in routine care as clues to FM with a general rheumatology rather than FM-specific questionnaire.
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Affiliation(s)
- Kathryn A Gibson
- From the Department of Rheumatology, Liverpool Hospital, Liverpool, Sydney, New South Wales, Australia; University of New South Wales, Sydney, Australia; Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA; Ingham Institute for Applied Medical Research, Liverpool, Sydney, New South Wales, Australia. .,K.A. Gibson, MD, PhD, Department of Rheumatology, Liverpool Hospital, and University of New South Wales; I. Castrejon, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center; J. Descallar, BSc, Mbiostat, University of New South Wales, and Ingham Institute for Applied Medical Research; T. Pincus, MD, Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center.
| | - Isabel Castrejon
- From the Department of Rheumatology, Liverpool Hospital, Liverpool, Sydney, New South Wales, Australia; University of New South Wales, Sydney, Australia; Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA; Ingham Institute for Applied Medical Research, Liverpool, Sydney, New South Wales, Australia.,K.A. Gibson, MD, PhD, Department of Rheumatology, Liverpool Hospital, and University of New South Wales; I. Castrejon, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center; J. Descallar, BSc, Mbiostat, University of New South Wales, and Ingham Institute for Applied Medical Research; T. Pincus, MD, Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center
| | - Joseph Descallar
- From the Department of Rheumatology, Liverpool Hospital, Liverpool, Sydney, New South Wales, Australia; University of New South Wales, Sydney, Australia; Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA; Ingham Institute for Applied Medical Research, Liverpool, Sydney, New South Wales, Australia.,K.A. Gibson, MD, PhD, Department of Rheumatology, Liverpool Hospital, and University of New South Wales; I. Castrejon, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center; J. Descallar, BSc, Mbiostat, University of New South Wales, and Ingham Institute for Applied Medical Research; T. Pincus, MD, Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center
| | - Theodore Pincus
- From the Department of Rheumatology, Liverpool Hospital, Liverpool, Sydney, New South Wales, Australia; University of New South Wales, Sydney, Australia; Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA; Ingham Institute for Applied Medical Research, Liverpool, Sydney, New South Wales, Australia.,K.A. Gibson, MD, PhD, Department of Rheumatology, Liverpool Hospital, and University of New South Wales; I. Castrejon, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center; J. Descallar, BSc, Mbiostat, University of New South Wales, and Ingham Institute for Applied Medical Research; T. Pincus, MD, Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center
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19
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Schmukler J, Jamal S, Castrejon I, Block JA, Pincus T. Fibromyalgia Assessment Screening Tools (FAST) Based on Only Multidimensional Health Assessment Questionnaire (MDHAQ) Scores as Clues to Fibromyalgia. ACR Open Rheumatol 2019; 1:516-525. [PMID: 31777833 PMCID: PMC6857971 DOI: 10.1002/acr2.11053] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 06/13/2019] [Indexed: 01/06/2023] Open
Abstract
Objective The study was designed to develop fibromyalgia assessment screening tool (FAST) indices based only on multidimensional health assessment questionnaire (MDHAQ) scores as clues to fibromyalgia (FM), analyzed for possible agreement with the 2011 FM criteria. Methods All patients with all diagnoses complete an MDHAQ at each visit in routine care. The MDHAQ includes scores for physical function, pain, global assessment, fatigue, self-report painful joint count, and a 60-symptom checklist. MDHAQ items similar or identical to the 2011 FM criteria symptom severity scale (SSS) and widespread pain index (WPI) components of a polysymptomatic distress scale (PSD) were compiled into continuous MDHAQ-FM-SSS, MDHAQ-FM-WPI, and MDHAQ-FM-PSD indices. Ten candidate MDHAQ scores were analyzed against the 2011 FM criteria using descriptive statistics, Spearman correlations, kappa statistics, and receiver operating characteristic curves for the area under the curve (AUC). MDHAQ candidate variables with the highest AUC were compiled into cumulative MDHAQ-FAST indices of three (FAST3) or four (FAST4) scores. Results The highest AUCs among MDHAQ scores were seen for symptom checklist, painful joint count, fatigue, and pain, which are included in FAST4; FAST3-F excludes pain, and FAST3-P excludes fatigue. AUCs for FAST3-P, FAST3-F, and FAST4, as well as continuous MDHAQ-FM scores, all were greater than 0.92, indicating excellent criterion validity. Kappa statistics versus the 2011 criteria were 0.63-0.68, higher than 0.41-0.47 versus physician ICD-10 diagnoses. Conclusion Pragmatic FAST3, FAST4, and MDHAQ-FM indices are similar to FM criteria to screen for FM in routine care. It is more feasible to collect the same MDHAQ, which is informative in all rheumatic diseases studied, from each patient than to ask different patients with different diagnoses to complete different questionnaires.
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Affiliation(s)
- Juan Schmukler
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Shakeel Jamal
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Isabel Castrejon
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Joel A Block
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Theodore Pincus
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, 60612, USA
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20
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Chua JR, Jamal S, Riad M, Castrejon I, Malfait AM, Block JA, Pincus T. Disease Burden in Osteoarthritis Is Similar to That of Rheumatoid Arthritis at Initial Rheumatology Visit and Significantly Greater Six Months Later. Arthritis Rheumatol 2019; 71:1276-1284. [PMID: 30891933 DOI: 10.1002/art.40869] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 02/21/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To analyze disease burden in osteoarthritis (OA) according to Multidimensional Health Assessment Questionnaire (MDHAQ)/Routine Assessment of Patient Index Data 3 (RAPID3) scores at the initial visit and the 6-month follow-up visit, compared with rheumatoid arthritis (RA) as a benchmark for high disease burden. METHODS All patients with all diagnoses at the Rush University Medical Center Division of Rheumatology complete a paper MDHAQ at all visits, saved as a PDF in the electronic health record. MDHAQ 0-10 scores for physical function, pain, and patient global assessment (compiled into RAPID3 0-30 scores) and additional scales at the initial and 6-month follow-up visits, for new OA and RA patients seen from 2011 to 2017, were compared. OA and RA patients were classified as self-referred or physician-referred, and RA patients were classified as disease-modifying antirheumatic drug (DMARD)-naive or having prior-DMARD treatment. Patient groups were compared using t-tests and analysis of variance, adjusted for age, disease duration, body mass index (BMI), education, and ethnicity. RESULTS Compared with RA patients, OA patients had higher age, BMI, and disease duration. At initial visit, the mean RAPID3 did not differ significantly in OA versus DMARD-naive RA patients, whether self- or physician-referred (range 14.8-16.4 [P = 0.38]), or in all OA patients versus DMARD-naive RA patients versus prior-DMARD RA patients (15.0, 15.7, and 15.8, respectively [P = 0.49]). After 6 months, RAPID3 was improved to 13.3, 10.3, and 10.8, respectively, which represented substantially greater improvement in RA patients than OA patients (P < 0.001). Similar results were seen for most self-reported measures and in adjusted analyses. CONCLUSION MDHAQ/RAPID3 scores are similar in OA and RA patients at the initial visit, but higher in OA patients than in RA patients 6 months later, reflecting superior RA treatments. The same MDHAQ/RAPID3 allows comparisons of disease burdens in different diseases.
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Affiliation(s)
| | | | - Mariam Riad
- Rush University Medical Center, Chicago, Illinois
| | | | | | - Joel A Block
- Rush University Medical Center, Chicago, Illinois
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21
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Delgado-Enciso I, Paz-Garcia J, Valtierra-Alvarez J, Preciado-Ramirez J, Almeida-Trinidad R, Guzman-Esquivel J, Mendoza-Hernandez MA, Garcia-Vega A, Soriano-Hernandez AD, Cortes-Bazan JL, Galvan-Salazar HR, Cabrera-Licona A, Rodriguez-Sanchez IP, Martinez-Fierro ML, Delgado-Enciso J, Paz-Michel B. A phase I-II controlled randomized trial using a promising novel cell-free formulation for articular cartilage regeneration as treatment of severe osteoarthritis of the knee. Eur J Med Res 2018; 23:52. [PMID: 30355362 PMCID: PMC6199741 DOI: 10.1186/s40001-018-0349-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 10/15/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND A promising novel cell-free bioactive formulation for articular cartilage regeneration, called BIOF2, has recently been tested in pre-clinical trials. The aim of the present study was to evaluate the efficacy and safety of BIOF2 for intra-articular application in patients with severe osteoarthritis of the knee. METHODS A prospective, randomized, 3-arm, parallel group clinical trial was conducted. It included 24 patients with severe osteoarthritis of the knee (WOMAC score 65.9 ± 17). Before they entered the study, all the patients were under osteoarthritis control through the standard treatment with nonsteroidal anti-inflammatory drugs (NSAIDs), prescribed by their family physician. Patients were distributed into three groups of 8 patients each (intra-articular BIOF2, total joint arthroplasty, or conservative treatment with NSAIDs alone). The WOMAC score, RAPID3 score, and Rasmussen clinical score were evaluated before treatment and at months 3, 6, and 12. BIOF2 was applied at months 0, 3, and 6. Complete blood count and blood chemistry parameters were determined in the BIOF2 group before treatment, at 72 h, and at months 1, 3, 6, and 12. In addition, articular cartilage volume was evaluated (according to MRI) at the beginning of the study and at month 12. RESULTS The NSAID group showed no improvement at follow-up. Arthroplasty and BIOF2 treatments showed significant improvement in all the scoring scales starting at month 3. There were no statistically significant differences between the BIOF2 group and the arthroplasty group at month 6 (WOMAC score: 19.3 ± 18 vs 4.3 ± 5; P = 0.24) or month 12 (WOMAC score: 15.6 ± 15 vs 15.7 ± 17; P = 1.0). Arthroplasty and BIOF2 were successful at month 12 (according to a WOMAC score: ≤ 16) in 75% of the patients and the daily use of NSAIDs was reduced, compared with the group treated exclusively with NSAIDs (RR = 0.33, 95% CI 0.12-0.87, P = 0.02. This result was the same for BIOF2 vs NSAIDs and arthroplasty vs NSAIDs). BIOF2 significantly increased the articular cartilage by 22% (26.1 ± 10 vs 31.9 ± 10 cm2, P < 0.001) and produced a significant reduction in serum lipids. BIOF2 was well tolerated, causing slight-to-moderate pain only upon application. CONCLUSIONS The intra-articular application of the new bioactive cell-free formulation (BIOF2) was well tolerated and showed no significative differences with arthroplasty for the treatment of severe osteoarthritis of the knee. BIOF2 can regenerate articular cartilage and is an easily implemented alternative therapy for the treatment of osteoarthritis. Trial registration Cuban Public Registry of Clinical Trials (RPCEC) Database RPCEC00000250. Registered 08/15/2017-Retrospectively registered, http://rpcec.sld.cu/en/trials/RPCEC00000250-En .
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MESH Headings
- Adult
- Anti-Inflammatory Agents, Non-Steroidal/administration & dosage
- Anti-Inflammatory Agents, Non-Steroidal/pharmacology
- Arthroplasty, Replacement, Knee
- Blood Cell Count
- Cartilage, Articular/drug effects
- Cartilage, Articular/growth & development
- Cell-Free System/chemistry
- Cell-Free System/metabolism
- Chondrocytes/drug effects
- Chondrogenesis/drug effects
- Female
- Humans
- Injections, Intra-Articular
- Male
- Mesenchymal Stem Cells/chemistry
- Mesenchymal Stem Cells/metabolism
- Middle Aged
- Osteoarthritis, Knee/blood
- Osteoarthritis, Knee/drug therapy
- Osteoarthritis, Knee/physiopathology
- Osteoarthritis, Knee/surgery
- Regeneration/drug effects
- Steroids/administration & dosage
- Steroids/pharmacology
- Treatment Outcome
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Affiliation(s)
- Ivan Delgado-Enciso
- Instituto Estatal de Cancerologia, Colima State Health Services, 28000, Colima, Mexico
- School of Medicine, University of Colima, 28030, Colima, Mexico
| | - Juan Paz-Garcia
- Centro Hospitalario Union, Villa de Álvarez, 28970, Colima, Mexico
| | | | | | | | | | | | - Alberto Garcia-Vega
- Hospital General de Zona No. 1 IMSS, Villa de Álvarez, 28983, Colima, Mexico
| | - Alejandro D Soriano-Hernandez
- Instituto Estatal de Cancerologia, Colima State Health Services, 28000, Colima, Mexico
- School of Medicine, University of Colima, 28030, Colima, Mexico
| | - Jose L Cortes-Bazan
- Instituto Estatal de Cancerologia, Colima State Health Services, 28000, Colima, Mexico
| | - Hector R Galvan-Salazar
- School of Medicine, University of Colima, 28030, Colima, Mexico
- Hospital General de Zona No. 1 IMSS, Villa de Álvarez, 28983, Colima, Mexico
| | - Ariana Cabrera-Licona
- Esteripharma México, S.A. de C.V, Patricio Sanz 1582, Colonia del Valle Centro, 03100, Ciudad de México, Mexico
| | - Iram P Rodriguez-Sanchez
- School of Biological Sciences, Universidad Autonoma de Nuevo Leon, 64460, Monterrey, Nuevo León, Mexico
| | - Margarita L Martinez-Fierro
- Molecular Medicine Laboratory, Academic Unit of Human Medicine and Health Sciences, Universidad Autónoma de Zacatecas, 98160, Zacatecas, Mexico
| | - Josuel Delgado-Enciso
- Foundation for Cancer Ethics, Education and Research of the Cancerology State Institute, 28085, Colima, Mexico
| | - Brenda Paz-Michel
- Esteripharma México, S.A. de C.V, Patricio Sanz 1582, Colonia del Valle Centro, 03100, Ciudad de México, Mexico.
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Coates LC, Tillett W, Shaddick G, Pincus T, Kavanaugh A, Helliwell PS. Value of the Routine Assessment of Patient Index Data 3 in Patients With Psoriatic Arthritis: Results From a Tight-Control Clinical Trial and an Observational Cohort. Arthritis Care Res (Hoboken) 2018; 70:1198-1205. [PMID: 29112801 DOI: 10.1002/acr.23460] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 10/31/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To analyze the Routine Assessment of Patient Index Data 3 (RAPID3), a patient-reported, composite index, designed initially for feasibility in clinical care. RAPID3 was developed in rheumatoid arthritis, but has been found useful in many rheumatic diseases. We analyzed RAPID3 in patients with psoriatic arthritis (PsA). METHODS Post hoc analyses were performed on 2 independent data sets, the Tight Control of Psoriatic Arthritis (TICOPA) clinical trial, and the Long-Term Outcome in Psoriatic Arthritis Study (LOPAS II), an observational cohort. RAPID3 (range 0-30) is the total of three 0-10 scores for the Health Assessment Questionnaire disability index (recalculated from 0-3), pain visual analog scale (VAS), and global VAS. RAPID3 scores were compared to the Psoriatic Arthritis Disease Activity Score (PASDAS), the Disease Activity in Psoriatic Arthritis (DAPSA), and other available clinical measures, according to Spearman's correlation coefficients, standardized response mean, SEM, smallest detectible difference, minimally important difference (in patients who improved), and receiver operating characteristic curves. RAPID3 remission was compared to criteria for both standard minimal disease activity (MDA) and very low disease activity (VLDA). RESULTS RAPID3 was correlated significantly with PASDAS in TICOPA (r = 0.79, P < 0.01) and with DAPSA in LOPAS II (ρ = 0.59, P < 0.01), and with most other measures in both data sets. RAPID3 discriminated between tight control and standard care in TICOPA at 48 weeks at levels comparable to DAPSA and the PASDAS (P < 0.01). RAPID3 remission discriminated treatment groups in TICOPA intermediate between MDA and VLDA criteria. CONCLUSION RAPID3 appears comparably informative to PASDAS and DAPSA in PsA, with greater feasibility for routine clinical care.
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Affiliation(s)
- Laura C Coates
- Leeds Institute of Rheumatic and Musculoskeletal Medicine and Leeds Teaching Hospitals NHS Trust, Leeds, and University of Oxford, Oxford, UK
| | - William Tillett
- Royal National Hospital for Rheumatic Diseases and University of Bath, Bath, UK
| | | | | | - Arthur Kavanaugh
- University of California at San Diego School of Medicine, San Diego
| | - Philip S Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Annapureddy N, Giangreco D, Devilliers H, Block JA, Jolly M. Psychometric properties of MDHAQ/RAPID3 in patients with systemic lupus erythematosus. Lupus 2018; 27:982-990. [DOI: 10.1177/0961203318758503] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- N Annapureddy
- Division of Rheumatology and Immunology, Vanderbilt University, Nashville, TN, USA
| | - D Giangreco
- Division of Rheumatology, Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - H Devilliers
- Internal Medicine and Systemic Disease Unit, Dijon University Hospital, Dijon, France
| | - J A Block
- Division of Rheumatology, Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - M Jolly
- Division of Rheumatology, Department of Medicine, Rush University Medical Center, Chicago, IL, USA
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24
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Routine Assessment of Patient Index Data 3 Score and Psoriasis Quality of Life Assess Complementary Yet Different Aspects of Patient-Reported Outcomes in Psoriasis and Psoriatic Arthritis. J Clin Rheumatol 2018; 24:319-323. [PMID: 29319548 DOI: 10.1097/rhu.0000000000000630] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Psoriasis Quality of Life (PQoL-12) is a validated composite tool assessing patients' quality of life (QoL) with psoriasis (PsO) and psoriatic arthritis (PsA). Routine Assessment of Patient Index Data 3 (RAPID3), measuring physical function, pain, and patient global assessment, is used for rheumatoid arthritis. Routine Assessment of Patient Index Data 3 has not been used to assess PsO/PsA patients' QoL. OBJECTIVE The aim of this study was to investigate the correlation between PQoL-12 and RAPID3 in PsO and PsA patients in a cross-sectional and longitudinal analyses. METHODS Data came from PsO and PsA patients seen from 2008 to 2015 at Oregon Health & Science University (n = 558: 393 with PsO and 165 with PsA). Nonlinear least squares regressions modeled PQoL-12 with functions of RAPID3, controlling for time since first visit. Nonparametric ROC determined RAPID3 scores best correlating with PQoL-12 cutoffs. RESULTS Among the PsO cohort, PQoL-12 was explained by RAPID3, the square of RAPID3, time since first visit, and the square of time since first visit; adjusted R = 0.414. For the PsA cohort, PQoL-12 was explained by RAPID3, change in slope of RAPID3 at 2.28, time since first visit, the square of time since first visit; adjusted R = 0.340. Routine Assessment of Patient Index Data 3 cutoffs for PQoL-12 scores of 48 and 96 (mild and moderate QoL impairment) in PsO were 1.55 and 5.72 and in PsA were 1.89 and 6.34. CONCLUSIONS Routine Assessment of Patient Index Data 3 weakly correlated with PQoL-12, indicating these indices assess different aspects of PsO and PsA. Routine Assessment of Patient Index Data 3 fails to capture mental health information that greatly impacts patients' QoL, whereas PQoL-12 fails to capture the physical and functional aspects of the disease. Results indicate the importance of capturing mental health assessment in order to create a comprehensive tool to measure how psoriatic disease affects patients' QoL.
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25
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El-Haddad C, Castrejon I, Gibson KA, Yazici Y, Bergman MJ, Pincus T. MDHAQ/RAPID3 scores in patients with osteoarthritis are similar to or higher than in patients with rheumatoid arthritis: a cross-sectional study from current routine rheumatology care at four sites. RMD Open 2017; 3:e000391. [PMID: 29225915 PMCID: PMC5708309 DOI: 10.1136/rmdopen-2016-000391] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 04/17/2017] [Accepted: 05/12/2017] [Indexed: 11/25/2022] Open
Abstract
Objective To compare patients with a primary diagnosis of osteoarthritis (OA) versus rheumatoid arthritis (RA) for scores on a patient self-report MDHAQ/RAPID3 (Multidimensional Health Assessment Questionnaire/Routine Assessment of Patient Index Data 3), and for physician global assessment (DOCGL). Methods All patients with all diagnoses complete an MDHAQ/RAPID3 at all routine rheumatology visits in the waiting area before seeing a rheumatologist at four sites, one in Australia and three in the USA. The two-page MDHAQ includes 0–10 scores for physical function (in 10 activities), pain and patient global assessment [on 0–10 visual analogue scales (VAS)], compiled into a 0–30 RAPID3, as well as fatigue and self-report painful joint count scales. Rheumatologists estimate a 0–10 DOCGL VAS. Demographic, MDHAQ/RAPID3 and DOCGL data from a random visit were compared in patients with RA versus patients with OA using multivariate analysis of variance, adjusted for age, disease duration and formal education level. Results Median RAPID3 was higher in OA versus RA at all four sites (11.7–16.8 vs 6.2–11.8) (p<0.001 at three sites). Median DOCGL in OA versus RA was 5 vs 4, 4 vs 3.7, 2.2 vs 2.5 and 2 vs 1. Patterns were similar for individual RAPID3 items, fatigue and painful joint scales, and in stratified analyses of patients aged 55–70. Conclusion Patient MDHAQ/RAPID3 and physician DOCGL indicate similar or higher disease burden in OA versus RA. Routine MDHAQ/RAPID3 allows direct comparisons of the two diseases. The findings suggest possible revision of current clinical and public policy views concerning OA.
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Affiliation(s)
- Carlos El-Haddad
- Department of Rheumatology, Liverpool Hospital, Liverpool, Australia
| | - Isabel Castrejon
- Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Kathryn A Gibson
- Department of Rheumatology, Liverpool Hospital, Liverpool, Australia.,Ingham Research Institute, Liverpool, Australia.,Rheumatology, University of New South Wales, Sydney, NSW, Australia
| | - Yusuf Yazici
- NYU Hospital for Joint Diseases, New York University School of Medicine, New York, New York, USA
| | - Martin J Bergman
- Department of Arthritis and Rheumatology, Taylor Hospital, Ridley Park, Pennsylvania, USA
| | - Theodore Pincus
- Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
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26
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Pincus T, Block JA, Yazici Y, Bergman MJ, Sokka T. Limited Value of the Multi‐Biomarker Disease Activity Assay Compared to the Routine Assessment of Patient Index Data 3 (RAPID3) Score in the Prognosis of Important Clinical Outcomes in Rheumatoid Arthritis: Comment on the Article by Fleischmann et al and Accompanying Editorial by Davis. Arthritis Rheumatol 2017; 69:866-867. [DOI: 10.1002/art.40022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 12/08/2016] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Yusuf Yazici
- Hospital for Joint Diseases, New York UniversityNew York NY
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Hendrikx J, de Jonge MJ, Fransen J, Kievit W, van Riel PL. Systematic review of patient-reported outcome measures (PROMs) for assessing disease activity in rheumatoid arthritis. RMD Open 2016; 2:e000202. [PMID: 27651921 PMCID: PMC5013514 DOI: 10.1136/rmdopen-2015-000202] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 01/25/2016] [Accepted: 02/13/2016] [Indexed: 01/29/2023] Open
Abstract
Patient assessment of disease activity in rheumatoid arthritis (RA) may be useful in clinical practice, offering a patient-friendly, location independent, and a time-efficient and cost-efficient means of monitoring the disease. The objective of this study was to identify patient-reported outcome measures (PROMs) to assess disease activity in RA and to evaluate the measurement properties of these measures. Systematic literature searches were performed in the PubMed and EMBASE databases to identify articles reporting on clinimetric development or evaluation of PROM-based instruments to monitor disease activity in patients with RA. 2 reviewers independently selected articles for review and assessed their methodological quality based on the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) recommendations. A total of 424 abstracts were retrieved for review. Of these abstracts, 56 were selected for reviewing the full article and 34 articles, presenting 17 different PROMs, were finally included. Identified were: Rheumatoid Arthritis Disease Activity Index (RADAI), RADAI-5, Patient-based Disease Activity Score (PDAS) I & II, Patient-derived Disease Activity Score with 28-joint counts (Pt-DAS28), Patient-derived Simplified Disease Activity Index (Pt-SDAI), Global Arthritis Score (GAS), Patient Activity Score (PAS) I & II, Routine Assessment of Patient Index Data (RAPID) 2–5, Patient Reported Outcome-index (PRO-index) continuous (C) & majority (M), Patient Reported Outcome CLinical ARthritis Activity (PRO-CLARA). The quality of reports varied from poor to good. Typically 5 out of 10 clinimetric domains were covered in the validations of the different instruments. The quality and extent of clinimetric validation varied among PROMs of RA disease activity. The Pt-DAS28, RADAI, RADAI-5 and RAPID 3 had the strongest and most extensive validation. The measurement properties least reported and in need of more evidence were: reliability, measurement error, cross-cultural validity and interpretability of measures.
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Affiliation(s)
- Jos Hendrikx
- Department of IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands; Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marieke J de Jonge
- Department of IQ Healthcare , Radboud University Medical Center, Radboud Institute for Health Sciences , Nijmegen , The Netherlands
| | - Jaap Fransen
- Department of Rheumatology , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Wietske Kievit
- Department for Health Evidence , Radboud University Medical Center, Radboud Institute for Health Sciences , Nijmegen , The Netherlands
| | - Piet Lcm van Riel
- Department of IQ Healthcare , Radboud University Medical Center, Radboud Institute for Health Sciences , Nijmegen , The Netherlands
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28
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Castrejón I, Pincus T, Wendling D, Dougados M. Responsiveness of a simple RAPID-3-like index compared to disease-specific BASDAI and ASDAS indices in patients with axial spondyloarthritis. RMD Open 2016; 2:e000235. [PMID: 27486525 PMCID: PMC4947741 DOI: 10.1136/rmdopen-2015-000235] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 05/23/2016] [Accepted: 05/29/2016] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the responsiveness of a simple routine assessment of patient index data (RAPID3)-like index that includes only 3 patient self-report measures (physical function, pain and patient global estimate) compared to that of traditional composite indices to assess change in patients with axial spondyloarthritis (Ax-SpA). Methods Devenir des Spondylarthropathies Indifférenciées Récentes (DESIR) is a prospective cohort of patients with inflammatory back pain suggestive of Ax-SpA. The study included 461 patients, who met the Assessment of SpondyloArthritis International Society (ASAS) classification criteria for Ax-SpA. A simple RAPID3-like index was compared with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the AS Disease Activity Score (ASDAS) scores for responsiveness over 6 months. Construct validity was also evaluated through Pearson correlations and discrimination of disease activity through standardised mean differences for the 3 indices. Results The RAPID3-like index was correlated significantly with BASDAI (r=0.84, p<0.005) and ASDAS-C-reactive protein (CRP) (r=0.74, p<0.005), similar to correlations of BASDAI with ASDAS-CRP (r=0.76, p<0.005). The percentage of patients with inactive disease ranged from 9% to 25% and with high activity from 10% to 45%, according to various measures. The capacity to discriminate between high and low disease activity was similar for the 3 indices. The strength of agreement of RAPID3 with ASDAS-CRP was moderate (0.44) and lower with BASDAI (0.37). Responsiveness over 6 months was slightly higher for ASDAS-CRP and the RAPID3-like index than that for BASDAI. Conclusions The RAPID3-like index provides similar information to BASDAI and ASDAS-CRP concerning responsiveness over 6 months. RAPID3 appears feasible to assess patients with Ax-SpA quantitatively over time in busy clinical settings.
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Affiliation(s)
| | | | - Daniel Wendling
- CHRU de Besançon, Université de Franche-Comté , Besançon , France
| | - Maxime Dougados
- Department of Rheumatology-Hôpital Cochin , Paris Descartes University, Assistance Publique-Hôpitaux de Paris INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité , Paris , France
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Routine Assessment of Patient Index Data (RAPID3) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) Scores Yield Similar Information in 85 Korean Patients With Ankylosing Spondylitis Seen in Usual Clinical Care. J Clin Rheumatol 2016; 21:300-4. [PMID: 26308349 PMCID: PMC4629489 DOI: 10.1097/rhu.0000000000000277] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Disease-specific ankylosing spondylitis (AS) indices, including BASDAI (Bath AS Disease Activity Index), BASFI (Bath AS Functional Index), ASDAS (AS Disease Activity Score), and BASMI (Bath AS Metrology Index), are widely used in clinical trials and in some clinical settings, but not in most routine care. Laboratory tests usually are the only quantitative measures included in routine care of AS patients, but often are poorly informative. Routine Assessment of Patient Index Data 3 (RAPID3) on a Multidimensional Health Assessment Questionnaire (MDHAQ) is feasible and informative in many rheumatic diseases.
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Castrejón I, Dougados M, Combe B, Fautrel B, Guillemin F, Pincus T. Prediction of Remission in a French Early Arthritis Cohort by RAPID3 and other Core Data Set Measures, but Not by the Absence of Rheumatoid Factor, Anticitrullinated Protein Antibodies, or Radiographic Erosions. J Rheumatol 2016; 43:1285-91. [DOI: 10.3899/jrheum.141586] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2016] [Indexed: 01/21/2023]
Abstract
Objective.To identify baseline variables that predict remission according to different criteria in rheumatoid arthritis (RA) in a comprehensive French ESPOIR early arthritis database.Methods.Individual variables and indices at baseline were analyzed in 664 patients for capacity to predict remission either 6 or 12 months later according to 4 criteria that require a formal joint count: the American College of Rheumatology/European League Against Rheumatism Boolean criteria, the Simplified Disease Activity Index, the Clinical Disease Activity Index, and the 28-joint Disease Activity Score; and 2 remission criteria that do not require a formal joint count: the Routine Assessment of Patient Index Data 3 (RAPID3) and the RAPID3 ≤ 3 + swollen joint, using univariate and multivariate logistic regressions.Results.Remission was predicted significantly 6 and/or 12 months later in 26.8%–51.4% of patients, according to all 6 criteria by younger age, low index scores, and better status for the 6/7 clinical RA core dataset measures: tender joint count, swollen joint count (SJC), physician’s global estimate, patient self-report Health Assessment Questionnaire (HAQ) physical function, pain, and patient’s global estimate. Remission was not predicted by the absence of “poor prognosis RA” indicators, rheumatoid factor (RF), anticitrullinated protein antibodies (ACPA), or radiographic erosions. In multivariate regressions that included only 3 variables, low HAQ function predicted remission by all criteria as effectively as SJC, erythrocyte sedimentation rate, or C-reactive protein.Conclusion.Younger age and 6 core dataset clinical measures, but not the absence of traditional “poor prognosis RA” indicators, RF, ACPA, or radiographic erosions, predicted remission according to 6 criteria, including 2 without a formal joint count.
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Abstract
Patient-reported outcome (PRO) measures are an important component to assessing disease impact and therapy response in patients with psoriatic arthritis (PsA). Overall, there are few PsA-specific PROs. Most PROs used in PsA are borrowed from other diseases (eg, rheumatoid arthritis and ankylosing spondylitis) or general population PROs. PROs are used in PsA clinical trials and in the clinical management of PsA. In this review, we discuss the most commonly used PRO in PsA, including their inclusion in composite measures. Future studies may be helpful to determine the best performing PROs in patients with PsA.
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Affiliation(s)
- Ana-Maria Orbai
- Division of Rheumatology, Johns Hopkins University, Asthma and Allergy Building, Room 1B19, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, USA.
| | - Alexis Ogdie
- Division of Rheumatology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, White Building, Room 5024, 3400 Spruce Street, Philadelphia, PA 19104, USA
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Curtis JR, Churchill M, Kivitz A, Samad A, Gauer L, Gervitz L, Koetse W, Melin J, Yazici Y. A Randomized Trial Comparing Disease Activity Measures for the Assessment and Prediction of Response in Rheumatoid Arthritis Patients Initiating Certolizumab Pegol. Arthritis Rheumatol 2016; 67:3104-12. [PMID: 26316013 PMCID: PMC5063165 DOI: 10.1002/art.39322] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 08/04/2015] [Indexed: 12/19/2022]
Abstract
Objective The aim of the Patient/Physician Reported Efficacy Determination In Clinical Practice Trial (PREDICT; ClinicalTrials identifier NCT01255761) was to compare the patient‐reported Routine Assessment of Patient Index Data 3 (RAPID‐3) instrument with the investigator‐based Clinical Disease Activity Index (CDAI) for assessing certolizumab pegol (CZP) treatment response in rheumatoid arthritis patients at 12 weeks and to predict the treatment response at week 52 using the data from week 12 (coprimary end points). Methods Patients received 400 mg of CZP at weeks 0, 2, and 4 (loading dose), followed by 200 mg every 2 weeks thereafter. Patients were randomized 1:1 to assessment with the RAPID‐3 or the CDAI. Responder classification was performed at week 12; treatment response was defined as a score of ≤6 or a 20% improvement over baseline on the RAPID‐3 or a score of ≤10 or a 20% improvement over baseline on the CDAI. Long‐term treatment success was defined as a Disease Activity Score in 28 joints using the erythrocyte sedimentation rate (DAS28‐ESR) of ≤3.2 at week 52. Comparisons were made for the coprimary end points using noninferiority methods. Patients with improvement of <1 on the CDAI score or with no improvement on the RAPID‐3 score at week 12 or patients with high levels of disease activity (CDAI score >22 or RAPID‐3 score >12) at 2 consecutive visits were withdrawn from the study. Results Patients had longstanding disease (mean 8.9 years) and high levels of disease activity (mean scores of 6.3 on the DAS28‐ESR, 16.1 on the RAPID‐3, and 40.2 on the CDAI). Previous anti–tumor necrosis factor therapy had failed in 55.5% of them. At week 12, a total of 64.7% (by RAPID‐3) and 76.4% (by CDAI) of the patients were classified as responders (difference of −11.9% [95% confidence interval −18.4%, −5.3%]). At week 52, a total of 31.5% (by RAPID‐3) and 32.3% (by CDAI) of the responders achieved a low level of disease activity on the DAS28‐ESR (difference of −1.3% [95% confidence interval −9.3%, 6.6%]). Conclusion The CDAI classified more patients as CZP responders at week 12 than did the RAPID‐3. Although these outcome measures were not statistically comparable, the positive predictive value for low disease activity at week 52 was similar. As these tools cover differing domains of therapy response, further evaluation for clinical disease activity assessments and treatment decisions is needed.
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Affiliation(s)
| | | | - Alan Kivitz
- Altoona Arthritis and Osteoporosis Center, Duncansville, Pennsylvania
| | | | | | | | | | - Jeffrey Melin
- Jeffrey M. Melin BioPharma Consulting, LLC, Philadelphia, Pennsylvania
| | - Yusuf Yazici
- New York University Hospital for Joint Diseases, New York, New York
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Che H, Roux C, Etcheto A, Rothenbuhler A, Kamenicky P, Linglart A, Briot K. Impaired quality of life in adults with X-linked hypophosphatemia and skeletal symptoms. Eur J Endocrinol 2016; 174:325-33. [PMID: 26783348 DOI: 10.1530/eje-15-0661] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Adults with X-linked hypophosphatemia (XLH) may suffer from skeletal symptoms leading to functional disability. No data on their quality of life (QoL) have been reported so far. Our objectives were to evaluate the QoL and its determinants in XLH adults. PATIENTS AND METHODS We conducted a prospective study in XLH adults, who consulted for musculoskeletal symptoms between 2013 and 2014. We assessed their QoL using HAQ, RAPID3 and SF36, and analysed the variables associated with low QoL. We compared their QoL to that of patients affected with axial spondyloarthritis (ax-SpA) (paired on age and gender), a rheumatologic disorder with a known low QoL. RESULTS Fifty-two XLH adults (37 women (71.1%); mean age 41.8±13.3 years) were included; 44 (84.6%) patients had an altered QoL. Increased age and presence of structural lesions were significantly associated with worse QoL (HAQ, RAPID3) (P<0.05). Presence of enthesopathies was significantly associated with worse RAPID3 (OR=4.45 (1.09-18.29), P=0.038). Treatment with phosphate supplements and vitamin D in XLH adults were significantly associated with a better SF36-mental component score (OR=0.14 (0.03-0.57), P=0.007 and OR=0.26 (0.07-0.98), P=0.047 respectively). QoL was significantly worse in XLH than in ax-SpA adults (VAS pain, SF36-PCS, RAPID3) (P<0.05). CONCLUSION Our study showed i) QoL of XLH adults is altered and significantly worse than that of ax-SpA patients (VAS pain, SF36-PCS and RAPID3), ii) structural lesions and especially enthesopathies are associated with a worse QoL and iii) treatment using phosphate supplements and/or vitamin D is associated with a better mental health score.
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MESH Headings
- Adult
- Case-Control Studies
- Cohort Studies
- Familial Hypophosphatemic Rickets/diagnostic imaging
- Familial Hypophosphatemic Rickets/epidemiology
- Familial Hypophosphatemic Rickets/physiopathology
- Female
- Fractures, Bone/diagnostic imaging
- Fractures, Bone/epidemiology
- Fractures, Bone/physiopathology
- Genetic Diseases, X-Linked/diagnostic imaging
- Genetic Diseases, X-Linked/epidemiology
- Genetic Diseases, X-Linked/physiopathology
- Humans
- Male
- Middle Aged
- Osteoarthritis/diagnostic imaging
- Osteoarthritis/epidemiology
- Osteoarthritis/physiopathology
- Osteoarthritis, Hip/diagnostic imaging
- Osteoarthritis, Hip/epidemiology
- Osteoarthritis, Hip/physiopathology
- Osteoarthritis, Knee/diagnostic imaging
- Osteoarthritis, Knee/epidemiology
- Osteoarthritis, Knee/physiopathology
- Osteoarthritis, Spine/diagnostic imaging
- Osteoarthritis, Spine/epidemiology
- Osteoarthritis, Spine/physiopathology
- Prospective Studies
- Quality of Life
- Radiography
- Rheumatic Diseases/diagnostic imaging
- Rheumatic Diseases/epidemiology
- Spondylarthritis/diagnostic imaging
- Spondylarthritis/epidemiology
- Spondylarthritis/physiopathology
- Spondylarthropathies/diagnostic imaging
- Spondylarthropathies/epidemiology
- Spondylarthropathies/physiopathology
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Affiliation(s)
- Hélène Che
- Department of RheumatologyFrench Reference Center for Genetic Bone Diseases, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, 27 rue du Faubourg Saint Jacques, 75014 Paris, FranceINSERM U1153Paris, FranceParis-Descartes UniversityParis, FranceINSERM U1169Paris Sud University, Assistance Publique- Hôpitaux de Paris, French Reference Center for Rare Disorders of the Mineral Metabolism, Department of Endocrinology and Diabetology for Children, Bicêtre Hospital, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
| | - Christian Roux
- Department of RheumatologyFrench Reference Center for Genetic Bone Diseases, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, 27 rue du Faubourg Saint Jacques, 75014 Paris, FranceINSERM U1153Paris, FranceParis-Descartes UniversityParis, FranceINSERM U1169Paris Sud University, Assistance Publique- Hôpitaux de Paris, French Reference Center for Rare Disorders of the Mineral Metabolism, Department of Endocrinology and Diabetology for Children, Bicêtre Hospital, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France Department of RheumatologyFrench Reference Center for Genetic Bone Diseases, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, 27 rue du Faubourg Saint Jacques, 75014 Paris, FranceINSERM U1153Paris, FranceParis-Descartes UniversityParis, FranceINSERM U1169Paris Sud University, Assistance Publique- Hôpitaux de Paris, French Reference Center for Rare Disorders of the Mineral Metabolism, Department of Endocrinology and Diabetology for Children, Bicêtre Hospital, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France Department of RheumatologyFrench Reference Center for Genetic Bone Diseases, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, 27 rue du Faubourg Saint Jacques, 75014 Paris, FranceINSERM U1153Paris, FranceParis-Descartes UniversityParis, FranceINSERM U1169Paris Sud University, Assistance Publique- Hôpitaux de Paris, French Reference Center for Rare Disorders of the Mineral Metabolism, Department of Endocrinology and Diabetology for Children, Bicêtre Hospital, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
| | - Adrien Etcheto
- Department of RheumatologyFrench Reference Center for Genetic Bone Diseases, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, 27 rue du Faubourg Saint Jacques, 75014 Paris, FranceINSERM U1153Paris, FranceParis-Descartes UniversityParis, FranceINSERM U1169Paris Sud University, Assistance Publique- Hôpitaux de Paris, French Reference Center for Rare Disorders of the Mineral Metabolism, Department of Endocrinology and Diabetology for Children, Bicêtre Hospital, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
| | - Anya Rothenbuhler
- Department of RheumatologyFrench Reference Center for Genetic Bone Diseases, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, 27 rue du Faubourg Saint Jacques, 75014 Paris, FranceINSERM U1153Paris, FranceParis-Descartes UniversityParis, FranceINSERM U1169Paris Sud University, Assistance Publique- Hôpitaux de Paris, French Reference Center for Rare Disorders of the Mineral Metabolism, Department of Endocrinology and Diabetology for Children, Bicêtre Hospital, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
| | - Peter Kamenicky
- Department of RheumatologyFrench Reference Center for Genetic Bone Diseases, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, 27 rue du Faubourg Saint Jacques, 75014 Paris, FranceINSERM U1153Paris, FranceParis-Descartes UniversityParis, FranceINSERM U1169Paris Sud University, Assistance Publique- Hôpitaux de Paris, French Reference Center for Rare Disorders of the Mineral Metabolism, Department of Endocrinology and Diabetology for Children, Bicêtre Hospital, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
| | - Agnès Linglart
- Department of RheumatologyFrench Reference Center for Genetic Bone Diseases, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, 27 rue du Faubourg Saint Jacques, 75014 Paris, FranceINSERM U1153Paris, FranceParis-Descartes UniversityParis, FranceINSERM U1169Paris Sud University, Assistance Publique- Hôpitaux de Paris, French Reference Center for Rare Disorders of the Mineral Metabolism, Department of Endocrinology and Diabetology for Children, Bicêtre Hospital, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
| | - Karine Briot
- Department of RheumatologyFrench Reference Center for Genetic Bone Diseases, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, 27 rue du Faubourg Saint Jacques, 75014 Paris, FranceINSERM U1153Paris, FranceParis-Descartes UniversityParis, FranceINSERM U1169Paris Sud University, Assistance Publique- Hôpitaux de Paris, French Reference Center for Rare Disorders of the Mineral Metabolism, Department of Endocrinology and Diabetology for Children, Bicêtre Hospital, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France Department of RheumatologyFrench Reference Center for Genetic Bone Diseases, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, 27 rue du Faubourg Saint Jacques, 75014 Paris, FranceINSERM U1153Paris, FranceParis-Descartes UniversityParis, FranceINSERM U1169Paris Sud University, Assistance Publique- Hôpitaux de Paris, French Reference Center for Rare Disorders of the Mineral Metabolism, Department of Endocrinology and Diabetology for Children, Bicêtre Hospital, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
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Pincus T, Chua JR, Gibson KA. Evidence from a Multidimensional Health Assessment Questionnaire (MDHAQ) of the Value of a Biopsychosocial Model to Complement a Traditional Biomedical Model in Care of Patients with Rheumatoid Arthritis. JOURNAL OF RHEUMATIC DISEASES 2016. [DOI: 10.4078/jrd.2016.23.4.212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Theodore Pincus
- Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Jacquelin R Chua
- Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Kathryn A Gibson
- Rheumatology Department, Liverpool Hospital, University of New South Wales, and Ingham Research Institute, Liverpool, NSW, Australia
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Holt RJ, Fort JG, Grahn AY, Kent JD, Bello AE. Onset and durability of pain relief in knee osteoarthritis: Pooled results from two placebo trials of naproxen/esomeprazole combination and celecoxib. PHYSICIAN SPORTSMED 2015; 43:200-12. [PMID: 26313454 DOI: 10.1080/00913847.2015.1074852] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To further characterize time-to-first pain relief, effect size, correlations between various outcome measures and durability of relief for single-tablet naproxen 500 mg/esomeprazole 20 mg (NAP/ESO) given twice daily and celecoxib (CEL) (200 mg) given once daily versus placebo in knee osteoarthritis (OA). METHODS Unpublished data from two double-blind, double-dummy, placebo-controlled trials in which patients aged ≥ 50 years with knee OA were randomized to NAP/ESO (n = 487), CEL (n = 486) or placebo (n = 246) were pooled (NCT00664560 and NCT00665431). Acute response endpoints: 1) Time to first significant pain response, 2) Western Ontario and McMaster Osteoarthritis Index (WOMAC) pain subscale and 3) American Pain Society Patient Outcome Questionnaire (APS-POQ) scores. Sustainability endpoints: 1) Routine Assessment of Patient Index Data (RAPID3) and 2) WOMAC Stiffness, Pain and Total scores; and Patient Global Assessment (PGA) at 6 and 12 weeks. Effect sizes for all measures were calculated. Rescue pain medication use also was analyzed, as was the correlation of WOMAC to RAPID3. RESULTS NAP/ESO produced statistically significant decreases in WOMAC Pain on Days 2-7 and at Weeks 6 and 12 (all p < 0.05); most APS-POQ pain assessments with NAP/ESO were significantly improved on Days 2-7 compared with placebo (all p < 0.05). A good or excellent response occurred in a median of 6 days. RAPID3 and WOMAC total/stiffness/function/PGA scores decreased significantly at Weeks 6 and 12 (all p < 0.05). Placebo-adjusted WOMAC pain effect sizes were 0.44, 0.34 and 0.25 at Day 7, week 6 and week 12, respectively. RAPID3 to WOMAC total and WOMAC pain to RAPID3: Pain scores were highly correlated at 6 and 12 weeks (correlation coefficients >0.80). No significant differences in overall responses were found between CEL and NAP/ESO. CONCLUSION Naproxen/esomeprazole produced a significant absolute moderate early pain response, which was maintained for 12 weeks. RAPID3 was found to be highly correlated with the typical OA measure (WOMAC) and might be a useful clinical tool for measuring NSAID response. NCT00664560: https://clinicaltrials.gov/ct2/show/NCT00664560, NCT00665431: https://www.clinicaltrials.gov/ct2/show/NCT00665431.
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Affiliation(s)
- Robert J Holt
- a 1 University of Illinois-Chicago , College of Pharmacy , Chicago, IL, USA
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A patient-reported outcome measures-based composite index (RAPID3) for the assessment of disease activity in ankylosing spondylitis. Rheumatol Int 2015; 35:1575-80. [DOI: 10.1007/s00296-015-3256-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 03/13/2015] [Indexed: 01/22/2023]
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Routine Assessment of Patient Index Data 3 score (RAPID3) correlates well with Bath Ankylosing Spondylitis Disease Activity index (BASDAI) in the assessment of disease activity and monitoring progression of axial spondyloarthritis. Clin Rheumatol 2014; 34:117-24. [PMID: 25421013 DOI: 10.1007/s10067-014-2827-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 11/09/2014] [Indexed: 10/24/2022]
Abstract
Routine Assessment of Patient Index Data 3 (RAPID3) is a composite index, very useful for assessment of disease activity of various rheumatic diseases including RA. If RAPID3 can also reliably measure disease activity in axial spondyloarthritis (axSpA), it may prove to be a practical and effective quantitative assessment tool in busy practices. We studied the association of RAPID3 with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Patients with Ankylosing Spondylitis (AS) seen from 2007 to 2012 were classified as having AS or non-radiographic axial spondyloarthritis (nr-axSpA) using modified New York criteria and Assessment of SpondyloArthritis International Society criteria, respectively. Patients with simultaneous BASDAI and RAPID3 scores were enrolled (N = 112; 105 with AS, seven with nr-axSpA). Multiple regression and nonparametric receiver operating characteristics were used. Baseline mean (SD) BASDAI and RAPID3 were 4.2 (2.5) and 3.8 (2.3), respectively. Multiple linear regressions modeled a quadratic relationship between BASDAI and RAPID3 for 321 observations in 112 patients with axSpA (1) cross-sectionally: BASDAI predicted by RAPID3 (β = 1.171; s.e. = 0.113, p < 0.001) and RAPID3(2) (β = -0.037; s.e. = 0.014, p = 0.011) with an adjusted R (2) of 0.676; and (2) longitudinally: BASDAI predicted by RAPID3 (β = 1.196; s.e. = 0.111, p < 0.001), RAPID3(2) (β = -0.042; s.e. = 0.014, p = 0.004), and visit number (β = -0.142; s.e. = 0.038, p < 0.001) with an adjusted R (2) of 0.689. RAPID3 (correctly classified) corresponded to BASDAI scores of 2, 4, and 6: 1.40 (85.8 %), 3.33 (81.9 %), and 5.43 (87.1 %), respectively. RAPID3 correlates well with BASDAI in monitoring axSpA patients (including AS) in cross-sectional and longitudinal follow-up. Since it also correlates with measures of disease activity of other rheumatic diseases including RA, RAPID3 could be an attractive measure for assessing and monitoring disease activity of several conditions seen in busy rheumatology practices.
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Yokogawa N, Kaneko T, Nagai Y, Nunokawa T, Sawaki T, Shiroto K, Shimada K, Sugii S. Validation of RAPID3 using a Japanese version of Multidimensional Health Assessment Questionnaire with Japanese rheumatoid arthritis patients: characteristics of RAPID3 compared to DAS28 and CDAI. Mod Rheumatol 2014; 25:264-9. [PMID: 25156777 DOI: 10.3109/14397595.2014.948587] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To validate Routine Assessment of Patient Index Data 3 (RAPID3) using a Japanese version of Multidimensional Health Assessment Questionnaire (MDHAQ) with Japanese rheumatoid arthritis (RA) patients and to describe the characteristics of RAPID3 by comparison with Disease Activity Score 28 (DAS28) and Clinical Disease Activity Index (CDAI). METHODS The original MDHAQ was translated into Japanese with minor cultural modifications and was translated back in English. Test-retest reliability was evaluated in 50 Japanese RA patients and further validation was performed in 350 Japanese RA patients recruited by seven rheumatologists. RAPID3, CDAI, and DAS28 were assessed on two consecutive visits. RESULTS The test-retest reliability and the internal reliability of RAPID3 were excellent. Spearman's correlation coefficients between RAPID3 score versus CDAI score and DAS28 score were 0.761and 0.555. However, the agreement measured by kappa (weighted) for RAPID3 category versus CDAI category and for RAPID3 category versus DA28 category were 0.225 (0.382) and 0.187 (0.336). The sensitivity and specificity of "RAPID3 ≤ 3 and swollen joint ≤ 1" for predicting Boolean remission were 90.0% and 93.4%, respectively. CONCLUSIONS RAPID3 obtained by Japanese MDHAQ was validated with Japanese RA patients and the remission criteria were found to have excellent clinical utility in usual care.
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Affiliation(s)
- Naoto Yokogawa
- Department of Rheumatic Diseases, Tokyo Metropolitan Tama Medical Center , Fuchu, Tokyo , Japan
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Castrejón I, Yazici Y, Samuels J, Luta G, Pincus T. Discordance of Global Estimates by Patients and Their Physicians in Usual Care of Many Rheumatic Diseases: Association With 5 Scores on a Multidimensional Health Assessment Questionnaire (MDHAQ) That Are Not Found on the Health Assessment Questionnaire (H. Arthritis Care Res (Hoboken) 2014; 66:934-42. [DOI: 10.1002/acr.22237] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 11/12/2013] [Indexed: 01/14/2023]
Affiliation(s)
- Isabel Castrejón
- New York University School of Medicine and New York University Hospital for Joint Diseases; New York
| | - Yusuf Yazici
- New York University School of Medicine and New York University Hospital for Joint Diseases; New York
| | - Jonathan Samuels
- New York University School of Medicine and New York University Hospital for Joint Diseases; New York
| | | | - Theodore Pincus
- New York University School of Medicine and New York University Hospital for Joint Diseases; New York
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PINCUS THEODORE, GIBSON KATHRYNA, BERTHELOT JEANMARIEM. Is a Patient Questionnaire Without a Joint Examination as Undesirable as a Joint Examination Without a Patient Questionnaire? J Rheumatol 2014; 41:619-21. [DOI: 10.3899/jrheum.140074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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