Title:Are Patient Self-Report Questionnaires as "Scientific" as Biomarkers in "Treat-totarget" and Prognosis in Rheumatoid Arthritis?
Volume: 21
Issue: 2
Author(s): Theodore Pincus and Isabel Castrejon
Affiliation:
Keywords:
Patient self-report outcomes, quantitative assessment, self-report questionnaire, treat to target, disease activity.
Abstract: Information from patients traditionally is regarded as “subjective,” in contrast to “objective,” “scientific” laboratory data.
However, patient questionnaire scores for physical function are more significant to predict severe outcomes of rheumatoid arthritis (RA),
such as work disability and mortality, than radiographs or laboratory tests. Furthermore, the 3 RA Core Data Set patient self-report measures
of physical function, pain, and patient global estimate are as effective as radiographs or laboratory tests to distinguish active from
control treatments in clinical trials. A multidimensional health assessment questionnaire (MDHAQ) has been developed in routine clinical
care, to be completed by patients in 5-10 minutes and contribute to clinical decisions, in contrast to research questionnaires which
may provide extensive information, but often are lengthy, unfeasible for routine care, and not designed to add to clinical care. RAPID3
(routine assessment of patient index data) is an index included on the MDHAQ which is calculated in 5 seconds, compared with almost 2
minutes for RA indices that require a formal joint count, such as DAS28 (disease activity score with 28-joint count) or CDAI (clinical
disease activity index). MDHAQ with included RAPID3 scores appears as “scientific” as laboratory tests, formal joint counts, and indices
such as DAS28 and CDAI, to assess patient status using standard, protocolized, quantitative measurement. MDHAQ/RAPID3 helps
the patient prepare for the visit, enhances doctor-patient communication, and saves time for the physician. MDHAQ/RAPID3 is useful in
all rheumatic diseases, and can be incorporated into routine clinical care with minimal extra work for physicians and staff. MDHAQ in no
way prevents collection of formal joint counts, radiographs and other imaging studies, laboratory tests, or any other information regarded
as important by a rheumatologist. MDHAQ provides quantitative, "scientific” data, rather than gestalt impressions, regarding patient
status, change in status, prognosis, and outcomes of RA and all rheumatic diseases.
