72
Scientifi c Advantages of MDHAQ/RAPID3
The “scientifi c” value of MDHAQ/RAPID3 scores is supported by extensive evi-
dence (Table 3.4 ) [ 4 – 6 , 8 , 10 – 13 , 25 , 77 , 81 – 110 ]. As noted, physical function
scores on a patient self-report questionnaire are more signifi cant than laboratory
tests, radiographs, or other high-technology data to predict premature death [ 4 ,
11 – 13 ], confi rmed in a review of all 53 RA cohorts, which included prognostic
variables for RA mortality [ 15 ] (Fig. 3.3 ). Physical function scores on a patient self-
report questionnaire generally also are more signifi cant than laboratory tests or
radiographs to predict most other severe long-term outcomes of rheumatoid arthritis
(RA), including work disability [ 3 – 7 ], costs [ 8 , 9 ], and joint replacement surgery
[ 10 ]. Radiographic progression is the only major RA outcome predicted by labora-
tory tests, including rheumatoid factor, elevated ESR, elevated CRP, and the shared
epitope of the major histocompatibility locus [ 17 ]. However, physical function
scores are far more signifi cant than laboratory tests (or radiographic progression) in
prognosis of other severe RA outcomes.
Patient questionnaire scores are more reproducible than formal joint counts
[ 82 – 88 ] (Table 3.5 [ 111 ]) in large part because a single observer (in this case the
patient) is likely more consistent than two observers (a joint count has input from
both doctor and patient) [ 88 ]. RAPID3 is correlated signifi cantly with DAS28 and
CDAI in clinical trials [ 77 , 93 – 95 ] and clinical care [ 71 , 78 ] (Fig. 3.7 ), including
categories for high, moderate, low disease severity, and remission [ 71 , 78 , 80 , 95 ].
Individual patient self-report measures of physical function, pain, and patient global
estimate of status are as effi cient as joint counts and laboratory tests to distinguish
active from control treatments in clinical trials [ 89 – 92 ] (Fig. 3.8 ). RAPID3 gives
Table 3.4 Scientifi c advantages of MDHAQ/RAPID3
Scientifi c foundation of MDHAQ/RAPID3
1 MDHAQ scores are more reproducible than formal joint counts by physicians [ 82 – 88 ]
2 Individual patient self-report measures of physical function, pain, and patient global
estimate of status, and RAPID3, are as effi cient as joint counts, laboratory tests, DAS28 or
CDAI to distinguish active from control treatments in clinical trials [ 89 – 92 ]
3 RAPID3 is correlated signifi cantly with DAS28 and CDAI in clinical trials [ 77 , 93 – 95 ] and
clinical care [ 71 , 78 ], including categories for high, moderate, low severity and remission
[ 71 , 78 , 80 , 95 ]
4 Physical function scores on MDHAQ and other questionnaires are far more signifi cant than
radiographs or laboratory tests in the prognosis of severe outcomes in RA, including work
disability, costs, joint replacement surgery and premature death [ 4 – 6 , 8 , 10 – 13 , 25 , 96 – 100 ]
5 More likely to be abnormal in RA than laboratory tests [ 81 ]
6 More likely to be document incomplete response to methotrexate and initiation of biological
agent in RA than ESR [ 101 ]
7 RAPID3 provides criteria for remission in RA comparable to Boolean and SDAI criteria
[ 102 ]
8 RAPID3 is informative in most, if not all, rheumatic diseases[ 103 – 110 ]T. Pincus et al.