RAPID3, an index of only 3 patient self-report core data set measures, but not ESR, recognizes incomplete responses to methotrexate in usual care of patients with rheumatoid arthritis.

OBJECTIVE To perform a longitudinal cohort study concerning the capacity of prospectively-collected erythrocyte sedimentation rates (ESR) and scores for physical function, pain, patient global estimate, and routine assessment of patient index data (RAPID3) on a multidimensional health assessment questionnaire (MDHAQ), to recognize incomplete versus adequate responses to methotrexate in rheumatoid arthritis (RA) in one usual care setting, prior to description of RAPID3. METHODS All patients were seen in one academic setting, in which MDHAQ scores were collected in all patients at all visits in the infrastructure of care. ESR was collected in all RA patients. All 93 RA patients in whom methotrexate was initiated between 1996 and 2001 with available 5-year follow-up were analyzed. "Incomplete response" was defined as initiation of subsequent biological therapy and "adequate response" as no biological therapy over 5 years. Measures were analyzed at the baseline methotrexate visit and at a subsequent visit: in 30 "incomplete responders" when biological therapy was prescribed; and in 63 "adequate responders 2.6 years after methotrexate initiation (mean interval to biological therapy in "incomplete responders"). RESULTS ESR fell similarly by 33% to 36% in both groups. MDHAQ scores fell by 56% to 79% over 2.6 years in adequate responders but increased by 0% to 31% in incomplete responders. Median RAPID3 fell from 10.6 to 3.6 (low severity=3.1 to 6, remission≤3) in adequate responders and rose from 14.9 to 16.2 (high severity>12) in incomplete responders. CONCLUSION RAPID3, but not ESR, recognizes incomplete versus adequate methotrexate responses in usual clinical care, and may be useful in busy usual care settings.