RAPID3 index fails to assess mental health for psoriatic disease
The Routine Assessment of Patient Index Data 3 for rheumatoid arthritis cannot be used in patients with psoriasis and psoriatic arthritis as it fails to account for potentially significant mental health considerations, according to findings published in the Journal of Clinical Rheumatology.
The researchers also found that the Psoriasis Quality of Life (PQoL-12) measure lacks consideration for any physical and functional symptoms. The two measures, they added, are only weakly correlated to each other, as they are concerned with different aspects of psoriatic arthritis and psoriasis.
“These indices usually are specific to a particular disease, time consuming, and do not provide a holistic insight to the overall health status of the patient,” Kiana Vakil-Gilani, MPH, of the Pacific Northwest University of Health Sciences, in Portland, Oregon, told Healio Rheumatology. “[The Routine Assessment of Patient Index Data 3 (RAPID3)] is a composite index of physical function, pain and patient global estimate, it takes 5 to 10 seconds to calculate, and it correlates significantly with [Disease Activity Score 28] and [Clinical Disease Activity Index] in RA and [Bath Ankylosing Spondylitis Disease Activity Index] in [ankylosing spondylitis] patients.”
To determine if RAPID3 could serve as a substitute for PQoL-12, the researchers assessed how well the two correlated among patients with psoriatic arthritis and psoriasis.
“Not only would it save time in a busy clinical setting, but it would bring us a step closer to developing a widely used, comprehensive, yet simple tool to monitor the effect of disease on patients’ lives among multiple diseases,” Vakil-Gilani said.
The researchers collected data on 165 patients with psoriatic arthritis and 393 with psoriasis from the Oregon Health and Science University in Portland from 2008 to 2015. They used nonlinear least squares regressions to model PQoL-12 with functions of RAPID3, and controlled for time since the patient’s first visit. RAPID3 scores that best correlate with PQoL-12 cutoffs were found using a nonparametric receiver operating characteristic (ROC) curve.
According to the researchers, among patients with psoriasis, the PQoL-12 measure was covered by RAPID3, the square of RAPID3, time since first visit and the square of time since first visit (adjusted R2 = 0.414). Among patients with psoriatic arthritis, PQoL-12 measures were covered by RAPID3, the change in slope in RAPID3 at 2.28, the time since first visit and the square of the time since first visit (adjusted R2 = 0.34). RAPID3 cutoffs for PQoL-12 scores of 48 and 96. This suggests mild and moderate quality of life impairments were 1.55 and 5.72, respectively, among patients with psoriasis. For patients with psoriatic arthritis, they were 1.89 and 6.34, respectively.
“In this study, we found a weak correlation between RAPID3 and PQoL-12 scores,” Vakil-Gilani said. “This indicated that RAPID3 and PQoL-12 measure different aspects of the disease. RAPID3 fails to capture mental and psychological health information that greatly contribute to patients’ quality of life and often neglected, while PQoL-12 fails to capture physical and functional aspects of the disease.”
According to Vakil-Gilani, their findings underline the importance of assessing patients’ mental health.
“Results from this study highlight the importance of capturing mental health in any assessment in order to create a comprehensive tool to measure how psoriatic disease affects patients’ quality of life,” she said. “RAPID3 includes two questions with regards to patients’ mental health, which are not conventionally used in calculating the average RAPID3 and not incorporated in the total score. Incorporating these questions in the RAPID3 scores would potentially alter our results and convert RAPID3 into a more desirable and comprehensive tool.” – by Jason Laday
Disclosure: The researchers report no relevant financial disclosures.