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research, but appear impractical for usual care. Indeed, the only quantitative
clinical data in the medical records of most patients seen by rheumatologists are
laboratory tests, which, as we have previously seen, can be normal or not spe-
cifi c for a PMR fl are.
Every patient, regardless of diagnosis, seen at this academic rheumatology center
completes a multidimensional health assessment questionnaire (MDHAQ) ( Appendix 1 ).
The MDHAQ has been developed to provide quantitative data, rather than “gestalt”
clinical impressions, in usual rheumatology care [ 30 ]. Although it was developed
initially to assess disease status and changes over time in patients with RA, MDHAQ
has been found informative in patients with other diagnoses [ 31 ]. The MDHAQ is a
2-page, single-sheet instrument, adapted from the standard Health Assessment
Questionnaire (HAQ) to add information concerning a self- report joint count (includ-
ing hips and shoulder, which are typically affected in PMR patients), review of
symptoms, visual analogue scales for pain, patient global estimate, and fatigue, and
also includes an evaluation of morning stiffness and demographic data. Laboratory
data, mainly acute-phase reactants, and prednisone dose were retrospectively col-
lected through chart review. PMR patients with complete data seen between 2010
and 2014 were included in this analysis and a baseline visit and the most recent visit
were compared to evaluate improvement through PROs in comparison with predni-
sone doses and laboratory data. Thirty-four patients with PMR were analyzed.
Patient characteristics were typical of PMR populations (59 % females and mean age
71.6 years). The mean duration from the baseline visit to a most recent visit was
15.5 months. At initial presentation, Routine Assessment of Patient Index Data 3
(RAPID3) was 12.2, FN 2.2, pain 5.3, and PATGL 4.7, fatigue 3.9, and morning stiff-
ness 63.1 min; 64.7 % of the patients had painful hips, 79.4 % had painful shoulders,
73.5 % had abnormal ESR, and 70.6 % had abnormal CRP. Signifi cant improvement
was seen between baseline and last visit in mean level of RAPID3 and all other
MDHAQ measures, except in the fatigue score ( p < 0.05), as well as ESR and CRP
(Table 14.2 ). The most remarkable improvement was seen in morning stiffness and
hip involvement. The mean dose of prednisone was decreased from 12.2 mg at fi rst
visit to 4.3 mg at most recent visit in agreement with the clinical improvement seen
in these patients. In conclusion, improvement was seen according to MDHAQ/
RAPID3 scores in a similar range to ESR and CRP, documenting effective response
to prednisone.
Disease-specifi c questionnaires or measures , as the specifi c disease activity
index for PMR, may be optimal for clinical trials and other research studies, but it
is not feasible to have patients complete different self-report evaluations or ques-
tionnaires in busy clinical settings. MDHAQ completed by the patient in the waiting
area not only provides data at the onset of the visit, rather than acquired during a
visit, it also helps the patient prepare for the visit and may improve doctor–patient
communication.
I. Castrejon