RA Assessment Confirms Remission, Not Causes of Ongoing Pain
Online First
NOVEMBER 5, 2024
By Myles Starr
The Routine Assessment of Patient Index Data 3 (RAPID3) is the most common tool to determine physical functional, pain and global health in patients with rheumatoid arthritis. The assessment, based on patient-reported outcomes, saves time and helps identify patients in remission. However, RAPID3’s utility is limited because it cannot confirm that ongoing pain is caused by RA.
“One of the caveats of using patient-reported outcomes, including RAPID3, is that they are subjective in nature. Patients may not necessarily be able to pinpoint if their symptoms are attributable to RA or other comorbidities. Therefore, scores will need to be interpreted considering other comorbidities that may contribute toward the scoring,” explained study author Amanuel Kehasse, PharmD, PhD, a clinical specialist at Clearway Health, in Boston, who presented a poster outlining the research at NASP 2024 Annual Meeting & Expo, held in Nashville, Tenn.
The study included a total of 75 patients with RA enrolled in a Clearway Health specialty pharmacy services program. All study participants completed a RAPID3 assessment, generating a cumulative RAPID3 score that is an aggregate of the three domains of the questionnaire.
Domain 1 asks patients about their daily physical and functional limitations, such as the level of difficulty for the patient to dress themselves, get in and out of bed, or turning faucets on and off. Dr. Kehasse described Domain 1 as indicating the hallmarks of RA and a “fairly good indicator of RA disease activity.”
High scores on Domain 2, overall pain, and Domain 3, a global health assessment, may not be specific to RA. Therefore, an aggregate score of below 3 can reliably indicate that a patient is close to, or in, RA remission. However, a low (3.1-6), moderate (6.1-12) or high (>12) aggregate score needs to be interpreted with more caution.
Overall, data from the study indicated that RAPID3 can alert clinicians effectively to a need for treatment. Over the five-month study, 48.5% patients with moderate to severe disease activity improved their RAPID3 scores. However, investigation of the individual domain scores indicate more than three-fourths (76.4%) of study participants with moderate or higher RAPID3 scores had little to no physical function limitation. Furthermore, researchers concluded that more than 50% of patients who scored 5 or higher on their overall pain and global health assessment scores had symptoms not necessarily related to RA, again highlighting the need for clinician interpretation to ensure a high RAPID3 score is caused by RA and not a comorbidity.
Despite these limitations, RAPID3 remains a tool that is quick to administer (takes three to five minutes to complete) and easy to use. The tool also allows healthcare providers to remotely monitor disease activity and treatment effectiveness, particularly between visits to clinicians when “rheumatologists may not have the bandwidth to see these patients who need ongoing treatment at the required frequency,” Dr. Kehasse explained.
However, “RAPID3 should not be the sole measure used for monitoring RA and response to treatments,” explained Bryant R. England, MD, PhD, a clinician-investigator in the Division of Rheumatology at the University of Nebraska Medical Center (UNMC), in Omaha, who was not associated with the study.
To address the limitations of RAPID3, UNMC clinicians use the Clinical Disease Activity Index (CDAI) to assess treatment response in patients with RA. This measure includes patient global outcomes, provider global outcomes, tender joint count and swollen joint count. In conjunction with CDAI, UMNC staff also collect functional status using the Health Assessment Questionnaire II. Some physicians will also incorporate blood tests, such as the acute phase reactants (C-reactive protein or erythrocyte sedimentation rate), to further assess the presence of inflammation that is linked with RA. England explained that the advantage of using these tools in conjunction with one another is that clinicians get patient and provider input before making treatment decisions.
Dr. Kehasse plans to continue data collection to better understand what comorbidities have the greatest effect on using and interpreting the RAPID3 questionnaire, but ultimately stressed that RAPID3 is a measure that requires a clinician’s interpretation.
Drs. England and Kehasse reported no relevant financial disclosures.