AN INDEX WITHOUT FORMAL JOINT COUNTS, ROUTINE ASSESSMENT OF PATIENT INDEX DATA (RAPID3), TO HELP GUIDE TIGHT CONTROL OF RA IN STANDARD CARE: MOST PATIENTS WHO MEET DAS OR CDAI REMISSION OR HIGH ACTIVITY CRITERIA MEET IDENTICAL PRELIMINARY RAPID CRITERIA

Background: The disease activity score (DAS) and clinical disease activity index (CDAI) are valuable indices to monitor rheumatoid arthritis (RA). DAS and CDAI categories of remission, low activity, moderate activity and high activity have been proposed to help guide "tight control" of inflammatory activity, toward remission. Formal joint counts are required for a DAS or CDAI, but are not performed at most visits in standard care, so an index without formal joint counts, routine assessment of patient index data (RAPID3), has been developed. RAPID3 requires 10 seconds to score versus 90 seconds for a 28 joint count, and is correlated significantly with DAS in clinical trials and clinical care. RAPID4 adds a joint count by a physician/assessor (MDJC) or patient self-report (PTJC) to RAPID3.Objectives: To compare DAS and CDAI to RAPID3 and RAPID4 in 274 patients with RA, based on an RA disease activity index (RADAI) PTJC or one of 3 MDJC: 1- swollen (SJC), 2- tender (TJC), and 3- swollen and tender joint counts (STJC).Methods: 274 patients completed a multidimensional health assessment questionnaire (MDHAQ), for physical function, pain, patient global and RADAI PTJC scores, all 0-10 (adjusted with MDHAQ scoring templates). A 28 STJC was also performed, also adjusted to 0-10. RAPID3 includes 3 patient measures from the Core Data Set – physical function, pain, global estimate. RAPID 4 adds a RADAI PTJC or one of 3 MDJC: SJC, TJC, or STJC. Spearman correlations, weighted kappa scores, and cross tabulations of DAS and CDAI categories for remission (<2.6 or <3.3), low activity (2.6-3.2 or 3.3-11), moderate activity (3.21-5.1 or 11-26) and high activity (>5.1 or >26) versus RAPID categories for near remission (<1), low severity (1.01-2), moderate severity (2.01-4), and high severity (>4) were computed.Results: Correlations were 0.65-0.73 for DAS vs RAPID and 0.74-0.83 for CDAI vs RAPID (all p<0.001); weighted kappas were 0.43-0.53 for DAS vs RAPID and 0.45-0.57 for CDAI vs RAPID (all p<0.001). The data indicate excellent agreement, only marginally higher for RAPID4 with PTJC or MDJC vs RAPID3 with only patient data. Remission criteria were met by 101 (37% of all patients) for DAS and 56 (20%) for CDAI; 50-54% who met DAS remission and 70-77% CDAI remission criteria also met RAPID "near-remission" criteria. High activity was met by 49 (18%) for DAS and 30 (11%) for CDAI; 73% of DAS and 77-83% of CDAI high activity patients met RAPID high severity criteria. DAS and CDAI agreed with each RAPID score at similar levels. Table 1. Comparison of DAS and CDAI vs RAPID 3 and RAPID 4 RAPID 3 RAPID 4 RADAI RAPID 4 SJC RAPID 4 TJC RAPID 4 MDJC Total in DAS, CDAI category DAS vs RAPID Spearman Corr 0.66 0.65 0.72 0.73 0.71 DAS vs RAPID Weighted kappa 0.43 0.43 0.51 0.53 0.48 #(%)DAS Rem alsoRAPID NRem 50 (50%) 48 (48%) 53 (52%) 55 (54%) 52 (51%) 101(37%of all) #(%) DAS HiAc alsoRAPIDHiSev 36 (73%) 36 (73%) 36 (73%) 36 (73%) 36 (73%) 49(18%of all) CDAI vs RAPID Spearman Corr 0.74 0.81 0.83 0.81 0.81 CDAI vs RAPID Weighted kappa 0.45 0.48 0.55 0.57 0.57 #(%)CDAI Rem alsoRAPID NRem 39 (70%) 40 (71%) 43 (77%) 43 (77%) 43 (77%) 56(20% of all) #(%) CDAI HiAc alsoRAPIDHiSev 23 (77%) 24 (80%) 23 (77%) 25 (83%) 24 (80%) 30(11% of all) Rem=Remission, NRem=Near Remission, HiAc=High activity Hi Sev=High severity. Conclusion: Most patients who are classified as remission or high activity by DAS and CDAI are in identical "near remission" or "high severity" categories for each RAPID. RAPID might prove useful in standard rheumatology care.Citation: Ann Rheum Dis, volume 66, supplement II, year 2007, page 271Session: Health service and outcome research