LAUSR

Background Osteoarthritis (OA) commonly is regarded as less severe than rheumatoid arthritis (RA). However, limited data are available for direct comparisons, largely because different measures traditionally are used in RA – primarily a HAQ (Health Assessment Questionnaire) vs OA – a WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index). RAPID3 (Routine Assessment of Patient Index Data) on an MDHAQ (Multi-Dimensional HAQ) is a self-report index that is informative in RA and most rheumatic diseases, including OA.1 A recent analysis of unselected patients from 4 rheumatology settings indicated that RAPID3 and other MDHAQ scores were similar or higher in OA versus RA patients,2 but those findings were from a cross-sectional convenience sample of unselected patients likely affected by treatment, rather than from an initial visit prior to rheumatologic therapy. Objectives To analyse MDHAQ/RAPID3 scores in patients with a primary diagnosis of either OA or RA at their initial visit and at 6 month follow-up at an academic rheumatology centre. Methods At one site, all patients complete an MDHAQ/RAPID3 prior to seeing the rheumatologist. The 2-page MDHAQ/RAPID3 includes 0–10 scores for physical function (FN) (converted from 0–3) and visual analogue scale (VAS) scores for pain (PN) and patient global assessment (PATGL), compiled into a 0–30 RAPID3. New patients seen between 2013 and 2017 with physician-diagnosed primary OA or RA and compete RAPID3 data were studied. Mean FN, PN, PATGL and RAPID3 scores in RA and OA at baseline and 6 month follow-up (range 3–9 months) were compared for differences between first and second visits using t-tests, and between OA and RA using MANOVA. Results At first visit, mean RAPID3 was 15.9 in OA vs 15.3 in RA (table 1). At a mean of a 5 month (actual) follow-up visit, RAPID3 fell from 15.9 to 14.9 (-1.0, p=0.06) in OA vs 15.3 to 11.1 (-4.2, p<0.001) in RA, resulting in significantly higher scores in OA vs RA (table 1). These differences remained significant adjusted for age, sex, body mass index, and education level. Mean and standard deviation (SD) at first visit and 5 month follow up visit MDHAQ/RAPID3 of patients with OA and RA seen in routine care Measures OA (n=109) RA (n=102) OA vs RAp value OA vs RAp adjusted* Initial visit Function (0–10) 3.15 (1.9) 2.89 (2.2) 0.34 0.60 Pain (0–10) 7.01 (2.3) 6.36 (2.9) 0.07 0.49 PATGL (0–10) 5.69 (2.8) 5.85 (3.0) 0.69 0.30 RAPID3 (0–30) 15.9 (5.9) 15.3 (7.0) 0.52 0.47 5 months follow-up visit Function(0–10) 2.93 (1.9) 2.24 (2.2) 0.02 0.006 Pain (0–10) 6.36 (2.5) 4.60 (3.0) <0.001 0.03 PATGL (0–10) 5.62 (2.7) 4.10 (3.2) <0.001 0.001 RAPID3 (0–30) 14.9 (6) 11.1 (7.6) <0.001 0.001 *adjusted for age, sex, BMI and education Conclusions Patients with OA or RA have similar disease burdens at first visit to a rheumatology site, but OA patients have a considerably higher burden 5 months later, reflecting more effective treatments for RA than for OA. Nonetheless, OA is a severe disease at first visit, suggesting a need for further research in OA toward improved treatment and outcomes. MDHAQ/RAPID3 is feasible and useful to assess and monitor clinical status in routine care of patients with different rheumatic diseases. References [1] J Clin Rheumatol. 2013;19(4):169–74. [2] RMD Open2017;3:e000391. Disclosure of Interest J. Chua: None declared, I. Castrejon: None declared, J. Block: None declared, A.-M. Malfait: None declared, T. Pincus Shareholder of: Dr. Pincus holds a copyright and trademark on MDHAQ and RAPID3 for which he receives royalties and license fees. All revenue is used to support further development of quantitative questionnaire measures for patients and doctors in clinical rheumatology care.