Background Several outcomes and clinical response measures have been used in patients with polymyalgia rheumatica (PMR), but there is no consensus about the optimal endpoint for evaluating response to treatment. A PMR activity score has been proposed which includes three patient reported outcomes (PROs)1. RAPID3 is an index found on a multidimensional health assessment questionnaire (MDHAQ) only including PROs, which is effective to document improvement not only in RA but also in other rheumatic diseases2
Objectives To prospectively evaluate the performance of RAPID3 and other PROs included on the MDHAQ to document improvement in clinical status over time in patients with PMR.
Methods This study was conducted at an academic rheumatology center at which all patients complete a MDHAQ, which includes 0–10 scores for physical function (FN), pain (PN), and patient global estimate (PATGL), compiled into a 0–30 RAPID3. The MDHAQ also scores fatigue, morning stiffness, self-reported joint counts and demographic data. Data collection included MDHAQ, acute-phase reactants, and prednisone dose. PMR patients with complete data seen between 2010 and 2014 were included. A baseline visit and the most recent visit were compared using paired t-test and McNemar's test. Spearman correlation analysis for non-normally distributed variables was performed between RAPID3 and ESR and CRP.
Results 34 PMR patients seen in routine care were included: 59% were females, 71% Caucasian, and mean age was 71.6 years. The mean duration from a baseline visit to most recent visit was 15.5 months. At initial presentation, RAPID3 was 12.2, FN 2.2, pain 5.3, and PATGL 4.7, fatigue 3.9, and morning stiffness 63.1 minutes; 64.7% of the patients had painful hips, 79.4% had painful shoulders, 73.5% had abnormal ESR, and 70.6% had abnormal CRP. Significant improvement was seen between baseline and last visit in mean level of RAPID3 and all other MDHAQ measures, except fatigue (p<0.05), as well as ESR and CRP (Table). The mean dose of prednisone was decreased from 12.2 mg at first visit to 4.3 mg at most recent visit. The RAPID3 was significantly correlated with ESR (rho=0.52), and with CRP (rho=0.50).
Conclusions In patients with PMR, improvement was seen according to PROs included on a self-reported MDHAQ questionnaire in a similar range to ESR and CRP, documenting effective response to prednisone.
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Castrejon I, Bergman MJ, Pincus T. J Clin Rheumatol 2013;19:169–74.
Disclosure of Interest None declared
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