Rush University Medical Center, Chicago, Illinois.
Arthritis Rheumatol. 2019 Aug;71(8):1276-1284. doi: 10.1002/art.40869. Epub 2019 Jul 3.
To analyze disease burden in osteoarthritis (OA) according to Multidimensional Health Assessment Questionnaire (MDHAQ)/Routine Assessment of Patient Index Data 3 (RAPID3) scores at the initial visit and the 6-month follow-up visit, compared with rheumatoid arthritis (RA) as a benchmark for high disease burden.
All patients with all diagnoses at the Rush University Medical Center Division of Rheumatology complete a paper MDHAQ at all visits, saved as a PDF in the electronic health record. MDHAQ 0-10 scores for physical function, pain, and patient global assessment (compiled into RAPID3 0-30 scores) and additional scales at the initial and 6-month follow-up visits, for new OA and RA patients seen from 2011 to 2017, were compared. OA and RA patients were classified as self-referred or physician-referred, and RA patients were classified as disease-modifying antirheumatic drug (DMARD)-naive or having prior-DMARD treatment. Patient groups were compared using t-tests and analysis of variance, adjusted for age, disease duration, body mass index (BMI), education, and ethnicity.
Compared with RA patients, OA patients had higher age, BMI, and disease duration. At initial visit, the mean RAPID3 did not differ significantly in OA versus DMARD-naive RA patients, whether self- or physician-referred (range 14.8-16.4 [P = 0.38]), or in all OA patients versus DMARD-naive RA patients versus prior-DMARD RA patients (15.0, 15.7, and 15.8, respectively [P = 0.49]). After 6 months, RAPID3 was improved to 13.3, 10.3, and 10.8, respectively, which represented substantially greater improvement in RA patients than OA patients (P < 0.001). Similar results were seen for most self-reported measures and in adjusted analyses.
MDHAQ/RAPID3 scores are similar in OA and RA patients at the initial visit, but higher in OA patients than in RA patients 6 months later, reflecting superior RA treatments. The same MDHAQ/RAPID3 allows comparisons of disease burdens in different diseases.
根据多维健康评估问卷（MDHAQ）/常规评估患者指数数据 3（RAPID3）在初诊和 6 个月随访时的评分，分析骨关节炎（OA）的疾病负担，与类风湿关节炎（RA）作为高疾病负担的基准进行比较。
在拉什大学医学中心风湿病学分部就诊的所有患者在每次就诊时都要填写纸质 MDHAQ，并以 PDF 格式保存在电子健康记录中。比较了 2011 年至 2017 年期间新诊断的 OA 和 RA 患者在初诊和 6 个月随访时的 MDHAQ 0-10 分（综合为 RAPID3 0-30 分）和其他量表的物理功能、疼痛和患者总体评估（编译为 RAPID3 0-30 分），以及自评或医生转诊的 OA 和 RA 患者，以及 DMARD 初治或有既往 DMARD 治疗的 RA 患者。采用 t 检验和方差分析比较患者组，调整年龄、疾病持续时间、体重指数（BMI）、教育程度和种族因素。
与 RA 患者相比，OA 患者的年龄、BMI 和疾病持续时间更高。初诊时，自评或医生转诊的 OA 患者与 DMARD 初治 RA 患者的 RAPID3 均值无显著差异（范围为 14.8-16.4 [P = 0.38]），或所有 OA 患者与 DMARD 初治 RA 患者与既往 DMARD RA 患者的 RAPID3 均值也无显著差异（分别为 15.0、15.7 和 15.8 [P = 0.49]）。6 个月后，RAPID3 分别改善至 13.3、10.3 和 10.8，RA 患者的改善程度明显大于 OA 患者（P < 0.001）。在大多数自我报告的测量指标和调整后的分析中也观察到了类似的结果。
初诊时，OA 和 RA 患者的 MDHAQ/RAPID3 评分相似，但 6 个月后 OA 患者的评分高于 RA 患者，反映出 RA 治疗效果更好。同样的 MDHAQ/RAPID3 可以比较不同疾病的疾病负担。
