It was interesting to read that you administered the HAQ orally to the patient. This defeats the purpose of the questionnaire. Besides the possibility that the answers may be inaccurate (patients often like to “please” their doctors and may give answers they think you want to hear), it also makes HAQ use unrealistic for the majority of clinicians, who rightly feel that time is a valuable commodity. The questions included in the RAPID are simple and, in the vast majority of cases, require no assistance by anyone to complete. They include a physical function scale consisting of 10 activities, along with a patient global score (needed if you want to calculate DAS, Simplified Disease Activity Index [SDAI], or Clinical Disease Activity Index [CDAI]), along with a patient pain Visual Analogue Scale (VAS). For further simplicity, the usual 10-cm VAS has been changed to a 21-numbered circle format that eliminates the need to use a ruler or to have standardized photocopying.
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Explore This IssueJune 2007
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These three scores should look familiar to all rheumatologists, as they are the patient reported outcomes (PRO) measures used to calculate ACR scores. Once the actual office visit begins, I quickly score the RAPID and use the information to get an idea of how the patient is doing.
The time needed for me to get the scores and record the RAPID is 10 seconds. Compare this with the 90 seconds it takes to do a formal 28-joint count and the additional 14 seconds to calculate the DAS using the calculator on the DAS Web site. (These data were also presented at the 2006 ACR Annual Meeting.) And that assumes that the lab tests are available and that they were performed correctly. What’s just as important, the resultant score is an excellent measure of disease activity.
The total RAPID score is 0–30 or 0–10, the mean of the three scores. It gives comparable results to the SDAI and CDAI discussed by Drs. Smolen and Aletaha, with similar correlation to DAS. Our goal is to reach a score of 6 on a 0–30 scale or a mean score of 2, indicating low disease activity, or 3 on a 0–30 scale or a mean score of 1, indicating near remission. The major difference is that the RAPID does not include a formal joint count. This is an important distinction, as we have reduced the time required, but more importantly, we have a scale that can be done by everyone. Many studies have shown that, while virtually all rheumatologists perform a careful joint exam on every patient, very few do a formal joint count. While a formal joint count is essential in clinical trials, it has to be asked: Does it make sense to develop practice-based criteria on procedures that are not done in practice?