84
Conclusion
This chapter has summarized evidence that scores on a patient MDHAQ self- report
questionnaire and RheuMetric physician checklist may be regarded as meeting cri-
teria for “scientifi c” evidence from a patient history and physical examination, with
standardized, quantitative measures according to a protocol. Data from a patient
history and physical examination are more important for clinical decisions in RA
than laboratory tests, unlike many common chronic diseases. The MDHAQ also
provides pragmatic advantages of helping the patient prepare for the visit, improv-
ing doctor/patient communication, and saving time for the doctor with RAPID3
scores, self-report joint count, review of systems, and recent medical history.
Scoring RAPID3 on an MDHAQ requires 5 s, compared to almost 2 min for a
DAS28 or CDAI, while distinguishing active from control treatment in clinical tri-
als as effectively as these indices. RAPID3 scores are valuable in all rheumatic
diseases. Physical function according to patient questionnaire scores is the most
signifi cant predictor of severe clinical outcomes in RA, including work disability
and death. A Rheumatic checklist provides the clinical to document levels of infl am-
mation, damage, and/or distress, in formulating a clinical decision concerning diag-
nosis and management. It is suggested that MDHAQ/RAPID3 and RheuMetric be
considered in all routine rheumatology care in all settings, to improve assessment,
monitoring, documentation, and outcomes.
Table 3.11 Mean scores assigned by two rheumatologists in six diagnosis categories: rheumatoid
arthritis (RA), osteoarthritis (OA), fi bromyalgia (Fibro), systemic lupus erythematosus (SLE),
spondyloarthropathy (SPA), and gout (43). All physician scores ≥5 are indicated in bold font
Rheumatologist A RA
( n = 174)OA
( n = 32)Fibro
( n = 196)SLE
( n = 34)SPA
( n = 30)Gout
( n = 12)
Overall global 6.3 6.3 6.3 5.0 6.3 5.0
Infl ammation 7.0 3.3 2.3 3.6 7.7 6.0
Damage 5.0 6.0 1.7 2.3 4.3 3.0
Distress 4.0 3.7 9.0 6.3 4.0 2.3
Rheumatologist B RA
( n = 48)OA
( n = 67)Fibro
( n = 15)SLE
( n = 13)SPA
( n = 23)Gout
( n = 31)
Overall global 3.90 3.28 4.53 2.23 3.61 2.36
Infl ammation 4.35 0.79 0.94 2.28 4.35 2.64
Damage 2.18 3.56 1.65 0.76 1.65 0.44
Distress 0.91 0.97 6.13 1.02 1.35 0.77Adapted from [ 76 ]
Rheumatologist A: 478 new patients seen from 1996 to 2007
Rheumatologist B: 197 new patients seen between 2008 and 2012
T. Pincus et al.