Disease Burden in Osteoarthritis Is Similar to That of Rheumatoid Arthritis at Initial Rheumatology Visit and Significantly Greater Six Months Later

Abstract

Objective 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. Methods 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. Results 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. Conclusion 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.

Work disability and musculoskeletal disease

“…Given its prevalence in the community, even relatively small excesses in work disability are likely to contribute significantly to the overall burden. Combining this with the suggestion from a recent US study that disability from OA may be more recalcitrant to medical intervention compared to inflammatory disease, then we have another significant musculoskeletal contributor to the overall burden of work disability.…”

Multidimensional Health Assessment Questionnaire as an Effective Tool to Screen for Depression in Routine Rheumatology Care

“…The observation of higher depression screening scores on MDHAQ, PHQ-9, and HADS-D, as well as higher scores on almost all other MDHAQ items in patients with SpA versus RA, is not widely recognized (43,44). Rheumatic diseases differ widely in pathophysiology and treatment from the perspective of health professionals but are associated with common similar problems from the perspective of patients, including functional disability, pain, fatigue, and comorbidities, including depression (19,42).…”

Feasibility of dual-phase 99mTc-MDP SPECT/CT imaging in rheumatoid arthritis evaluation

“…In our work the changes in soft-tissue phase MCCR between baseline and 1-month follow-up post-therapy seems to be generally higher compared to the delayed osseous phase MCCR. The finding of increased soft-tissue phase MCCR in Group II (osteoarthritis) joints in individual participants categorized as responders to RA therapy may be supported by recently published work (34) demonstrating that, in independent patient groups with RA and OA, both diseases showed similar disease burden at presentation to rheumatologists; however, after treatment, OA was associated with a higher mean burden of disease than RA. A recent meta-analysis showed that RA-targeted therapies may not offer clinically significant pain relief above placebo in symptomatic OA (35).…”