Validación del cuestionario RAPID3 en la cohorte argentina ESPAXIA de pacientes con espondiloartritis axial / Validation of RAPID3 questionnaire in ESPAXIA Argentina cohort of patients with axial spondyloarthritis

Introducción: El RAPID3 (Routine Assessment of Patient Index Data 3) es un cuestionario sencillo, rápido y de cálculo simple que mostró un buen rendimiento en Artritis Reumatoidea, siendo capaz de reflejar el estado de enfermedad y la calidad de vida en estos pacientes. Objetivo: Validar el cuestionario RAPID3 en una cohorte de pacientes con EsP axial y evaluar su asociación con otras medidas de evaluación de la enfermedad. Materiales y métodos: Se incluyeron pacientes consecutivos ≥18 años de edad con diagnóstico de EsP axial (según criterios NY modificados 1987 y/o ASAS 2009). Todos los pacientes completaron los cuestionarios RAPID3, ASQoL, BASDAI y BASFI. La evaluación global de la enfermedad, tanto por el paciente como por el médico, se determinó mediante escala visual análoga (EVA). Se realizó examen físico con recuento articular (44) y evaluación de entesis (MASES). Se obtuvieron muestras de sangre para determinación de HLA-B27 y ERS. Se calculó ASDAS-ERS y SASDAS-ERS. Evaluación radiológica por BASRI por un evaluador ciego al estado clínico de los pacientes (CCI=>0,92). Se utilizó la versión traducida y validada en Argentina del RAPID3, el cual consiste en 10 preguntas acerca de capacidad funcional y 2 preguntas acerca de dolor y evaluación global de la enfermedad, con sus puntos de corte preestablecidos. Se determinó el tiempo para completar el cuestionario por parte del paciente y el tiempo para calcularlo por parte del médico. Resultados: Se incluyeron 51 pacientes, 39 de sexo masculino (76,5%), con una edad mediana 42 años (RIC 33-51) y tiempo mediano de evolución de la enfermedad de 20 años (RIC 10,3-27,6). El 90,5% presentaba HLA-B27. La mediana del RAPID3 fue 9 (RIC 3-12,8), BASDAI 3,35 (RIC 1,6-6), BASFI 3,4 (RIC 1,1-5,6), ASQoL 5 (RIC 1-9), SASDAS-ERS 15,9 (RIC 8-22,6), MASES 1 (RIC 0-3) y BASRI 4,5 (RIC 0-11). El cuestionario tuvo excelente reproducibilidad (CCI=0,97). El tiempo mediano para completar el RAPID3 fue de 2 minutos (RIC 0,91-3), y para calcularlo de 10 segundos (RIC 6-15). Se observó muy buena correlación del RAPID3 con SASDAS ERS (r:0,87), BASDAI (r:0,89), BASFI (r:0,8) y ASQoL (r:0,83) y buena con el MASES (r:0,58). Al evaluar los puntos de corte preestablecidos del RAPID3 y el SASDAS ERS, observamos buena concordancia entre los mismos (Kappa:0,5, p=0,0001). También encontramos muy buena asociación de los puntos de corte del RAPID3 y el BASDAI (p=0,0001). En la regresión lineal múltiple, utilizando como variable dependiente el puntaje total RAPID-3, ajustando por edad, sexo y tiempo de evolución de la enfermedad, se observó una asociación significativa con BASDAI (coef β: 0,55, p=0,0001), BASFI (coef β0,25, p=0,008), ASQoL (coef β: 0,22, p=0,02), como también con SASDAS ERS (coef β: 0,42, p=0,001). Conclusión: El RAPID3 es un cuestionario válido, confiable y reproducible para ser utilizado en EsP axial, simple para completar y calcular. Y además, tiene la ventaja de reflejar el estado de tres aspectos importantes de la enfermedad: actividad, capacidad funcional y calidad de vida.

Introduction: RAPID3 (Routine Assessment of Patient Index Data 3) is a simple, quick and simple calculation questionnaire that showed good performance in patients with rheumatoid arthritis, being able to reflect the state of disease and quality of life in these patients. Objective: To validate the RAPID3 questionnaire in a cohort of patients with axial spondyloarthritis (axSpa) and assess its association with other measures of the disease. Materials and methods: We included consecutive patients ≥18 years of age diagnosed with axSpa (according to modified NY criteria 1987 and/or ASAS 2009). All patients completed the RAPID3, ASQoL, BASDAI and BASFI questionnaires. The overall assessment of the disease both by the patient and the doctor was determined by visual analog scale (VAS). Physical examination was performed with joint count (44) and evaluation of enthesis (MASES). Blood samples for determination of HLA-B27 and ERS were obtained. ASDAS-ERS and SASDAS-ERS were calculated. X-rays were evaluated by BASRI by a blinded reader (CCI=>0.92). The translated and validated in Argentina RAPID3 version was calculated. Time to complete the questionnaire by the patient and time to calculate by the doctor were determined. Results: 51 patients were included, 39 were male (76.5%), median age 42 years (IQR 33-51) and median disease duration of 20 years (IQR 10.3-27.6). 90.5% had HLA-B27. Median RAPID3 was 9 (IQR 3-12.8), BASDAI 3.35 (IQR 1.6-6), BASFI 3.4 (IQR 1.1-5.6), ASQoL 5 (IQR 1-9), SASDAS-ESR 15.9 (IQR 8-22.6), MASES 1 (IQR 0-3) and BASRI 4.5 (IQR 0-11). The questionnaire had excellent reproducibility (ICC = 0.97). The median time to complete the RAPID3 was 2 minutes (IQR 0.91 to 3), and to calculate 10 seconds (IQR 6-15). RAPID3 had very good correlation with SASDAS ESR (r:0.87), BASDAI (r:0.89), BASFI (r=0.8) and ASQoL (r=0.83) and good with MASES (r:0.58). In multiple linear regression, using total RAPID score as dependent variable and adjusting for age, sex and disease duration, a significant association was observed with BASFI (β coeff 0.25, p=0.008), ASQoL (β coeff: 0.22, p=0.02), and mainly with SASDAS ERS (β coeff: 0.42, p=0.001) and BASDAI (0.55, p=0.0001). Conclusion: RAPID3 is a valid, reliable and reproducible questionnaire to be used in axSpa. It is simple to complete by the patient and to evaluate by the rheumatologist.

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

Patient self-report questionnaires such as a multidimensional health assessment questionnaire (MDHAQ) have advanced knowledge concerning prognosis, care, course and outcomes of rheumatoid arthritis (RA). The MDHAQ may overcome some limitations of a "biomedical model," the dominant paradigm of contemporary medical services, including limitations of laboratory tests, radiographs, joint counts, and clinical trials, to predict and depict the long-term course and outcomes of RA. A complementary "biopsychosocial model" captures components of a patient medical history on patient questionnaires as quantitative, standard, "scientific" scores for physical function, pain, fatigue, and other problems, rather than as 'subjective" narrative descriptions. A rationale for a biopsychosocial model in RA includes the importance of a patient history in diagnosis and management compared to biomarkers in many chronic diseases such as hypertension and diabetes. Some important observations which support a biopsychosocial model in RA based on patient questionnaires include that MDHAQ physical function scores are far more significant than radiographs or laboratory tests to predict severe RA outcomes such as work disability and premature death; patient self-report measures are more efficient than tender joint counts and laboratory tests to distinguish active from control treatments in RA clinical trials involving biological agents; and MDHAQ scores are more likely than laboratory tests to be abnormal at presentation and to document incomplete responses to methotrexate at initiation of biological agents. Patient questionnaires can save time for doctors and patients, and improve doctor-patient communication. A standardized database of MDHAQ scores consecutive patients over long periods might be considered by all rheumatologists in routine clinical care.

Comparison of ASDAS, RAPID3 and BASDAI in assessing disease activitiy of patients with ankylosing spondylitis / 第二军医大学学报

Objective To investigate the values of ASAS-endorsed disease activity score (ASDAS) and routine assessment of patient index data 3 (RAPID3) in assessing disease activity of patients with ankylosing spondylitis (AS) in China. Methods Questionnaires were used to obtain the general information and disease activity of 82 AS patients; and erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured in the venous blood samples. Correlation analysis and kappa consistency test were used to compare the value of traditional measures for assessing disease activity of AS including Bath ankylosing spondylitis disease activity index (BASDAI) with the new measures including ASDAS and RAPID3. Results ASDAS-CRP and RAPID3 had a good consistency in assessing AS activity (kappa value: 0.788), but both of them had poor consistency with BASDAI (kappa values: 0.342, 0.367). BASDAI, ASDAS and RAPID3 were well correlated with doctor global assessment (DOCGL) and patient global assessment (PATGL), and ASDAS and RAPID3 had stronger correlation with DOCGL and PATGL than BASDAI did (the r values of ASDAS-CRP, ASDAS-ESR, RAPID3, and BASDAI with DOCGL were 0.684, 0.720, 0.642 and 0.576; and those with PATGL were 0.822, 0.816, 0.851 and 0.725, respectively). Conclusion ASDAS is superior to BASDAI in assessing the disease activity of AS, making it a new promising index for evaluating disease activity and worth promoting. RAPID3 is convenient, simple, and independent to laboratory findings, and it has a good reliability and validity in evaluating disease activity of AS.

Routine Assessment of Patient Index Data 3 (RAPID3) is a Valid Index for Routine Care in Patients with Osteoarthritis.

Objective: To compare Routine Assessment of Patient Index Data 3 (RAPID3) on a Multidimensional Health Assessment Questionnaire (MDHAQ) with the Western Ontario and Mc-Master Universities Osteoarthritis Index (WOMAC) in patients with knee or hip osteoarthritis and to evaluate its reliability. Methods: 678 patients with hip or knee osteoarthritis were assessed in daily practice clinical care during 2009-2013. Patients completed an MDHAQ and so a RAPID3 was calculated (physical function, pain, patient global estimate). Pain, stiffness, and physical functions using the standard WOMAC indices for hip and knee osteoarthritis were assessed too; correlation between WOMAC total scores and RAPID3 scores were estimated with Spearman’s rho. Furthermore a linear regression model was developed with a coefficient of determination R2. Finally we evaluated validity and reliability of this index to evaluate that RAPID3 is not inferior to WOMAC. Results: RAPID3 and WOMAC were correlated significantly, with a global correlation Spearman’ rho index of 0.84 (P<0.01). Computing analysis for diagnosis the correlation index was 0.83 for hip osteoarthritis (p<0.01) and 0.87 for knee osteoarthritis. Conclusion: RAPID3 scores provide similar quantitative information to WOMAC in patients with hip or knee osteoarthritis.