So often when I’m listening to a scientific presentation about clinical care for Rheumatoid Arthritis, I would do the face-palm head-smack, if my shoulder would let me. Depending on who can hear me, I mutter softly or wail sarcastically, “If it’s not done, does this matter?” One example is measuring RA disease activity, especially with “Patient Outcome Measures,” which has always been a key topic on RA Warrior.
Bottom line – that’s right – at the top of the post. But, please keep reading.
- The various HAQ’s are mediocre tools used to gauge the effects of RA.
- The RAPID3 is superior, partly because it’s more feasible, increasing odds of its being used.
- If none of these measures are used in most cases, the debate is pointless.
When there are debates about patient outcome measures of Rheumatoid Arthritis, they are about which test is more consistent or accurate, not about whether they should be used. There are plenty of nit-picky technical articles about how to best compare and interpret various versions of the HAQ and other outcome measures, including this explicit discussion of clinical use and interpretation of RAPID tests.
But the question of its value seems to be settled: “A careful history and physical examination, including a nonquantitative joint examination, form the foundation of any encounter of a physician and patient with RA,” Journal of Rheumatology, Vol. 5, no. 11. In a fundamental discussion about assessing RA patients in 2009, RAPID3—An Index of Physical Function, Pain, and Global Status as “Vital Signs” to Improve Care for People with Chronic Rheumatic Diseases, Pincus wrote, “It is suggested that all rheumatologists would find it valuable to ask all patients to complete a MDHAQ and to score a RAPID3 at all visits of all patients in usual care.”
We’ve heard some of the top rheumatologists in the world start a conversation with, “We all do the HAQ and joint counts, but we know it’s not enough…” We do? My brother always used to ask me, “We? You got a mouse in your pocket?” It’s an 80’s saying that means, “You, and who else?” Do they assume all rheumatologists are measuring as they do?
Can we talk more about that mouse next time?
Pincus and Segurado reported in 2006 that “Most visits of most patients with rheumatoid arthritis to most rheumatologists do not include a formal quantitative joint count.” It’s not done either. It seems little measuring is done period, from the patients we’ve heard from so far.
If you are a rheumatology patient, how often does your rheumatologist count your joints or give you a RAPID or a HAQ to fill out?
If you are a care provider, how do you typically measure?
Postblog: We’ll continue to discuss measuring RA here. Whether you’re a care provider or a patient, I recommend the articles and PDF’s provided on this page by Pincus et. al.: “RAPID3 (Routine Assessment of Patient Index Data 3), a Rheumatoid Arthritis Index Without Formal Joint Counts for Routine Care: Proposed Severity Categories Compared to Disease Activity Score and Clinical Disease Activity Index Categories.” Some of these have been quoted on this site before, but this is a great list.
I realize the patients and doctors who read this blog are better educated and more involved and so may be more likely to be measuring, but let’s see what folks say over the next few weeks.
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