Book chapter
PROMs (MDHAQ/RAPID3) and Physician RheuMetric Measures
Patient Reported Outcome Measures in Rheumatic Diseases, pp 59-99
15 Sep 2016
Abstract
Information from a medical history and physical examination are far more prominent in diagnosis and management decisions in rheumatoid arthritis (RA) than vital signs, laboratory tests, or ancillary studies, in contrast to many other prevalent chronic diseases, such as hypertension and diabetes, particularly as laboratory tests have many limitations in rheumatic diseases. Medical history information can be recorded as scores on patient self-report questionnaires, to advance assessment of patient status from traditional “gestalt,” narrative impressions to quantitative data for diagnosis, management, prognosis, and outcomes. An index of only patient self-report measures, RAPID3 (routine assessment of patient index data) on an MDHAQ (multidimensional health assessment questionnaire) is as effective as laboratory tests and indices that include formal joint counts to distinguish active from control treatments in RA clinical trials, to document RA remission or severity status, and to monitor patient status and outcomes in routine care of all rheumatic diseases. Physical function on a patient questionnaire is more significant than radiographs or laboratory tests in the prognosis of severe RA outcomes of work disability, costs, and mortality. The MDHAQ also includes scales for fatigue, self-report joint count, review of systems, exercise, change in status, morning stiffness, recent medical history, and demographic data, and is feasible in busy clinical settings. RAPID3 is calculated in 5 s, versus almost 2 min for indices such as DAS28 and CDAI and is correlated significantly with both these indices. RheuMetric is a quantitative physician checklist that includes four 0–10 scores for a traditional physician global estimate, as well as for inflammation—reversible findings, damage—irreversible findings, and distress—symptoms explained by neither inflammation nor damage. Most indices for most rheumatic diseases, such as DAS28, CDAI, RAPID3, WOMAC, BASDAI, and most others, include at least 1 patient self-report measure, also designed initially to assess inflammation. However, high patient index scores suggesting active inflammation may result from organ damage (e.g., joint, kidney) and/or distress (e.g., fibromyalgia, depression). Recognition of whether clinical findings are reversible, irreversible, and/or distress-related, or 2 or all 3 of these bases, may be viewed as the expertise of a rheumatologist; recording formal quantitative physician scores may document that expertise and contribute to clinical decisions. RheuMetric results indicating that many patients with inflammatory rheumatic diseases also have substantial evidence of damage and/or distress may explain in part why rheumatology visits generally are more complex than many other types of internal medicine patient encounters. MDHAQ/RAPID3 and RheuMetric are recommended in routine rheumatology clinical care, to improve assessment, monitoring, documentation, and outcomes.
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2 citations in Scopus
Details
- Title
- PROMs (MDHAQ/RAPID3) and Physician RheuMetric Measures
- Creators
- Theodore Pincus - Rush University Medical CenterJacquelin Chua - Rush University Medical CenterMartin J. Bergman - Arthritis and Rheumatology, Taylor Hospital, Ridley Park, USAYusuf Yazici - New York University Langone Orthopedic HospitalKathryn A. Gibson - Liverpool Hospital
- Contributors
- Yasser El Miedany (Editor)
- Publication Details
- Patient Reported Outcome Measures in Rheumatic Diseases, pp 59-99
- Publisher
- Springer International Publishing; Cham
- Number of pages
- 41
- Resource Type
- Book chapter
- Language
- English
- Academic Unit
- Medicine (Graduate)
- Scopus ID
- 2-s2.0-85017077114
- Other Identifier
- 991021916904904721