A COMPOSITE INDEX OF PHYSICAL FUNCTION, PAIN, PATIENT GLOBAL AND JOINT COUNT, RAPID4 (ROUTINE ASSESSMENT OF PATIENT INDEX DATA): VIRTUALLY IDENTICAL RESULTS WITH A PATIENT SELF-REPORT OR PHYSICIAN/ASSESSOR JOINT COUNT OR NO JOINT COUNT IN RAPID3

Background: Routine assessment of patient index data (RAPID) composite scores, based on patient reported outcome (PRO) measures in the American College of Rheumatology (ACR) Core Data Set, without formal joint counts, have been developed to assess rheumatoid arthritis (RA) in standard rheumatology care, at which formal joint counts are not performed at most visits. RAPID3 includes physical function, pain, and patient global estimate; it distinguishes active from control treatments in clinical trials at levels similar to ACR and disease activity score (DAS) criteria. As the joint count is the most specific measure in RA, a version of RAPID which adds a joint count to RAPID3, termed RAPID4, has been developed. RAPID4 with a physician/assessor joint count (RAPID4MDJC) gives results similar to RAPID3 (and ACR and DAS Criteria)in clinical trials. RAPID4 with a rheumatoid arthritis disease activity index (RADAI) self-report joint count (RAPID4PTJC) has been developed for standard clinical care. We compared DAS28, RAPID3, RAPID4PTJC and RAPID4MDJC in 274 patients with RA seen in standard care, on whom both RAPID4PTJC and RAPID4MDJC were available.Objectives: To compare RAPID3, RAPID4MDJC, and RAPID4PTJC, and DAS28 in 274 patients with RA seen in standard clinical care.Methods: The 274 patients were evaluated at 3 sites according to 28 joint counts for swollen and tender joints, and a multidimensional health assessment questionnaire (MDHAQ), with self-report scores for physical function, pain, global estimate, RADAI self-report joint count, and RAPID3 and RAPID4 composite scores. All measures are scored or converted to 0-10 using scoring templates on the MDHAQ. The 28 joint count was also converted to 0-10 for RAPID4MDJC. DAS28 was calculated as in the literature. Four preliminary categories of RAPID scores are proposed: "near remission" = 0-1.0, "low severity" = 1.01-2.0, "moderate severity"= 2.01-4.0 and high severity >4.0. Spearman correlations and cross-tabulations were computed.Results: Significant correlations were seen between DAS and all RAPID measures, rho>0.65 (p,0.0001). Highly significant correlations of > 0.979 were seen between RAPID4MDJC vs RAPID4PTJC vs RAPID3 (all p<0.0001) were seen, indicating virtually identical data, as might be anticipated since 3 of the 4 measures were identical. Nonetheless, 64 of 67 patients (96%) in "near remission" (<1), according to RAPID4PTJC also scored <1 on RAPID4MDJC. Furthermore, 46 of 55 (84%) with RAPID4PTJC "low severity," 61 of 73 (84%) with "moderate severity," and 62 of 79 (78%) with "high severity" were in an identical category for RAPID4MDJC. RAPID 4PTJC patient joint count compared to RAPID4MDJC in 274 RA patients RAPID4 Joint Counts (JC) (0-10) RAPID4MDJC Total 0-1.0 Near remission 1.1-2.0 Low severity 2.1-4 Moderate severity 4.1-10 High severity RAPID4PTJC: 0-1.0 Near Remission 64 (96%) 3 (5%) 0 (0%) 0 (0%) 67 (24%) RAPID4PTJC: 1.1-2 Low Severity 5 (9%) 46 (84%) 4 (7%) 0 (0%) 55 (20%) RAPID4PTJC: 2.1-4 Moderate Severity 0 (0%) 12 (16%) 61 (84%) 0 (0%) 73 (27%) RAPID4PTJC: >4 High Severity 0 (0%) 0 (0%) 17 (22%) 62 (78%) 79 (29%) Total 69 (25%) 61 (22%) 82 (30%) 62 (23%) 274 Conclusion: RAPID4PTJC with a patient self-report joint count, RAPID4MDJC with a physician/assessor joint count, and RAPID3, with no joint count data, provide virtually identical information, and similar information to DAS. Any RAPID may be suitable for standard clinical care, balancing pragmatic and ideal considerations.Citation: Ann Rheum Dis, volume 66, supplement II, year 2007, page 270Session: Health service and outcome research