Elevated DAS28, CDAI, RAPID3 and five of seven RA core data set measures in patients with positive screens for anxiety, depression or fibromyalgia on an MDHAQ.

OBJECTIVE

To analyze three MDHAQ (Multidimensional Health Assessment Questionnaire) patient distress screening indices, MAS2 (MDHAQ anxiety screen), MDS2 (MDHAQ depression screen) and FAST3F (fibromyalgia assessment screening tool), for potential associations with elevated rheumatoid arthritis (RA) activity/severity indices in routine care patients.

METHODS

A cross-sectional database included the seven RA core data set measures and three MDHAQ patient distress indices. Mean individual measures and five indices-DAS28-ESR (disease activity score 28-erythrocyte sedimentation rate), DAS28-CRP (DAS28-C-reactive protein), SDAI (simplified disease activity index), CDAI (clinical disease activity index), and RAPID3 (routine assessment of patient index data),-and the number of patients classified into high, moderate, low or remission, were computed according to positive or negative MDHAQ screening indices, including in patients with 0,1 vs ≥2 swollen joints, analyzed using t tests and chi2 tests.

RESULTS

Among 173 patients, positive screening was seen in 37% for MAS2, 27% for MDS2, 31% for FAST3F and 45% for at least one of these three MDHAQ screening indices. All five RA indices and five of seven core data set measures were elevated significantly (P-value < 0.01), other than swollen joint count (SJC), ESR and CRP, in MAS2, MDS2 and/or FAST3F positive patients, generally to a higher activity/severity category. In the 27-41% of all patients with 0 or 1 SJC but moderate/high RA index activity/severity, a positive MDHAQ anxiety, depression and/or fibromyalgia screen was seen in 54-100%.

CONCLUSION

Five RA indices and five of seven individual core data set measures are elevated significantly in patients who screen positive for anxiety, depression and/or fibromyalgia on MDHAQ indices.