Routine assessment of patient index data (RAPID) scores
No single measure can serve as a “gold standard” for assessment of patient status
in rheumatoid arthritis (RA). Therefore, a pooled index (1), such as the American
College of Rheumatology (ACR) Core Data Set (2-4) and disease activity score (DAS)
(5;6), and more recently, a simplified disease activity index (SDAI) (7) and clinical
disease activity index (CDAI) (7) have been developed. All these indices include
a formal joint count of tender and swollen joints performed by a physician/assessor.
The joint count is the most specific measure to assess RA (8), and is regarded by
rheumatologists as the most important assessment measure (9). However, while most
rheumatologists perform careful qualitative joint examinations at most visits, a
formal quantitative joint count is not included at most visits of most patients
with RA to rheumatologists (10). Therefore, most care of patients with RA is conducted
without quantitative data, other than laboratory tests, which often are not informative,
or associated with false positive and false negative results (11).
An index of only the 3 ACR Core Data Set patient reported outcome (PRO) measures
- physical function, pain, and global estimate, is available on the health assessment
questionnaire (HAQ), and distinguishes active from control treatments at levels
similar to the ACR Core Data Set and DAS in clinical trials involving leflunomide
(12;13), methotrexate (12;13), and adalimumab (14). PRO indices are correlated with
the DAS in clinical trials (12-14) and in clinical settings (15). An index which
does not require formal joint counts might enhance feasibility to incorporate quantitative
data into standard rheumatology care. The additional indices are termed “routine
assessment of patient index data” (RAPID), as they have been designed for use in
a busy clinical setting; a number is added to indicate the number of individual
The prototype RAPID 3 includes physical function, pain, and patient global estimate,
the 3 patient measures from the Core Data Set (2-4). RAPID 3 is mathematically identical
to a patient activity score (PAS), but with a raw score of 0-30 and adjusted score
of 0-10 rather than 0-9 (15). The score for physical function is converted from
0-3 to 0-10 by multiplying by 3.33, using a template on the MDHAQ. Pain and global
estimate are assessed according to visual analog scales (VAS), both scored 0-10.
The three 0-10 scores for physical function, pain VAS, and global VAS, are added
together for a raw score of 0-30, and divided by 3 to give an adjusted 0-10 score
for comparison with other RAPID indices. The rationale for RAPID 3 is to include
the three PRO measures from the ACR Core Data Set, available on a standard patient
questionnaire, requiring no activity on the part of a health professional, other
than to calculate simple arithmetic totals.
RAPID 4 adds to RAPID 3 a rheumatoid arthritis disease activity index (RADAI) self-report
joint count, which includes 8 joints or joint groups, scored 0, 1, 2 or 3, for a
0-48 scale, which is recoded to 0-10, using scoring templates on the MHAQ, The rationale
for RAPID 4JC is that rheumatologists indicate that the joint count is the most
valuable measure to assess patients with RA (9), and the joint count is the most
specific measure of RA (8). A 66 tender joint count is converted to a 0-10 scale
using simple division by 6.6. The raw RAPID 4JC score is 0-40, i.e., the sum of
four 0-10 scores for physical function, pain VAS, global VAS, and tender joint count.
The raw RAPID 4JC score is divided by 4 to give an adjusted 0-10 score.
RAPID5 adds a physician global estimate (0-10) to RAPID4. The rationale for RAPID
5 is to include both the measure that most rheumatologists indicate is most valuable
to assess patients with RA, i.e., the joint count (9), and the measure with the
highest relative efficiency in clinical trials, i.e., physician/assessor estimate
of global status (16). RAPID 5 is therefore the most comprehensive RAPID index.
The RAPID 5 raw score is 0-50 and divided by 5 to give an adjusted 0-10 score.
Templates to score RAPID3, RAPID4,and RAPID5 are found at the right side of the
“For Office Use Only” section at the right. Templates at the bottom of page 1 of
the MDHAQ recode 0-30 scores for RAPID3, 0-40 scores for RAPID4, and 0-50 scores
for RAPID5 to 0-10. In general, RAPID3, 4, and 5 yield very similar scores, and
it is necessary to score only RAPID3, which can be accomplished in 10 seconds or
less. If the rheumatologist is more comfortable to include a joint count in the
index, RAPID5 requires about 20 seconds.
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