1. Patient Questionnaires Tutorial: Review of MDHAQ and score RAPID3
Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM
Patient Questionnaires Tutorial: Review of MDHAQ and score RAPID3
Theodore Pincus MD
Clinical Professor of Medicine
New York University

2. Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM
Complexities in quantitative assessment of patients with RA and rheumatic diseases
Laboratory tests are limited in diagnosis and treatment decisions
Treat radiograph before damage
No single ‘Gold Standard’ measure, eg, blood pressure, cholesterol, glucose, for diagnosis and management in all individual patients
Therefore, need indices of 3–7 measures

3. Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM
Complexities in quantitative assessment of patients with RA and rheumatic diseases
Patient history and physical examination is more important in clinical management decisions than in diseases with gold standard measure, eg, blood pressure, cholesterol, glucose
Patient history information may be captured as quantitative "scientific" data using structured patient self-report questionnaires

4. Psychological distress
Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM
MDHAQ:
Page 1 of 2
a - j: Physical
function
k, l, m:
Psychological distress
2. Pain
3. RADAI
Self-report
joint count
4. Patient global
estimate
RAPID3

5. Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM
2.7
9.5
9.0
21.2  
Visit 1 –
Baseline 5

6. Visit 1 2.7 9.5 9.0 21.2 43 Visit date Q-Function (0–10) Q-Pain (0–10)
Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM
Visit 1
Visit date
Visit 1
Q-Function (0–10)
2.7
Q-Pain (0–10)
9.5
Q-Global (0–10)
9.0
RAPID3 (0–30)
21.2
L-ESR 43
Prednisone
N-3qd
T-Methotrexate
N10qw
T-Folic acid
N1qd
T-Tylenol w/Codeine
30tid
T-Naproxen
880q6h
N=new drug, C=change in dose, T=taper, D/C=discontinue 6

7. Visit 2 – 2 months after baseline  0.5 1.0 
Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM
0.5
1.0  
Visit 2 –
2 months after baseline 7

8. Visit 2 2.7 9.6 0.3 8.9 21.2 0.6 43 8 Visit Date Q-Function (0-10)
Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM
Visit 2
Visit Date
4Nov03
13Jan04
Q-Function (0-10)
2.7
Q-Pain (0-10)
9.6
0.3
Q-Global (0-10)
8.9
RAPID3 (0-30)
21.2
0.6
L-ESR 43 8
T-Prednisone
N3qd
T-Methotrexate
N10qw
T-Folic Acid
N1qd
T-Tylenol w/Codeine
30tid
T-Naproxen
880q6h
N = new drug, C = change in dose, T = taper, D/C = discontinue 8

9. Visit 5 – 13 months after baseline   6.0 5.5 11.5         
Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM
Visit 5 –
13 months after baseline             
6.0 
5.5
11.5                   

10. Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM
Visit 5
Visit
Visit 1
Visit 2
Visit 3
Visit 4
Visit 5
Q-Function (0–10)
2.7
0.3
Q-Pain (0–10)
9.6
0.2
0.6
6.0
Q-Global (0–10)
8.9
1.0
5.5
RAPID3 (0–30)
21.2
0.8
1.6
11.5
L-ESR 43 8 13 10 14
T-Prednisone
N3qd
3qd
T-Methotrexate
N10qw
C20qw
20qw
15qw
T-Folic acid
N1qd
1qd
T-Tylenol w/Codeine
30tid
D/C
T-Naproxen
880q6h
440bid
N=new drug, C=change in dose, T=taper, D/C=discontinue 10

11. Visit 6 – 15 months after baseline   0.5 0.5            
Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM
Visit 6 –
15 months after baseline              
0.5
0.5                   

12. Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM
Visit 6
Visit
Visit 1
Visit 2
Visit 3
Visit 4
Visit 5
Visit 6
Q-Function (0–10)
2.7
0.3
Q-Pain (0–10)
9.5
0.5
0.0
6.0
Q-Global (0–10)
9.0
1.0
5.5
RAPID3 (0–30)
21.2
0.8
1.5
11.5
L-ESR 43 8 13 10 14
T-Prednisone
N3qd
3qd
T-Methotrexate
N10qw
C20qw
20qw
15qw
C25qw
C15qw
T-Folic acid
N1qd
1qd
T-Tylenol w/Codeine
30tid
D/C
T-Naproxen
880q6h
440bid
T-Adalimumab
N40qow
40qow
N=new drug, C=change in dose, T=taper, D/C=discontinue 12

13. Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM

14. Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM

15. Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM

16. Disease Duration (Years) Disease Duration (Years)
Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM
Cross-Sectional Data in Patients With RA: Cohort #2 in 1985 and Cohort #4 in 2000: MDHAQ Scores
1985
2000
2.0
1.5
1.0
0.5
0.0
2.0
1.5
1.0
0.5
0.0
MHAQ
MHAQ 5 10 15 20 5 10 15 20
Disease Duration (Years)
Disease Duration (Years)
Pincus, Sokka, Kautiainen, Arth Rheum 52:1009, 2005

17. Disease Duration (Years) Disease Duration (Years)
Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM
Cross-Sectional Data in Patients With RA: Cohort #2 in 1985 and Cohort #4 in 2000: Swollen Joint Count Scores
1985
2000 20 16 12 8 4 20 16 12 8 4
Swollen Joint Count 28
Swollen Joint Count 28 5 10 15 20 5 10 15 20
Disease Duration (Years)
Disease Duration (Years)
Pincus, Sokka, Kautiainen, Arth Rheum 52:1009, 2005

18. Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM
Cross-Sectional Data in RA Patients: Cohort # and Cohort #4-2000: Larsen X-Ray score,% of maximum
1985
2000
RF+
RF-
RF+
RF- 18

19. Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM
Patients seen for standard rheumatoid arthritis care have significantly better articular, radiographic, laboratory, and functional status in 2000 than in 1985
Measure
1985 n=125
2000 n=150 p
Swollen joints(0-28)
12 (6,16)
5 (2,10)
<0.001
X-Ray (Larsen )
20 (2,36)
3 (0,13)
ESR
33 (16 , 50)
20 (9,33)
0.016
Hemoglobin (g/L)
129(116,138)
136 (128,143)
0.002
MHAQ Function (0-3)
1.0 (0.6 , 1.4)
0.4 (0.1 , 1.0)
Pincus, Sokka, Kautiainen, Arth Rheum 52:1009, 2005 19

20. Jyvaskyla, Finland & Nashville, TN
Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM
Mtx in RA Care:
Jyvaskyla, Finland & Nashville, TN
Sokka, Pincus,. Rheumatology (Oxford) 47: , 2008.

21. Indices to assess patients with RA
Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM
Indices to assess patients with RA
ACR
DAS28
CDAI
RAPID3
# Tender joints √
0.56 sq rt (TJC28)
0-28 --
# Swollen joints
0.28sq rt (SJC28)
MD global
0-10
ESR or CRP
0.70  ln (ESR)
Patient function
Patient pain
Patient global
0.014  PTGL
TOTAL
0-76
0-30
Repeated studies, and now BeSt have shown that close supervision and monitoring of responses to drive treatment results in better patient outcome measures. However, very few physicians (12%) are obtaining and/or using these measures. Some of the reasons given include: they are too difficult to do outside of a clinical trial, they take too much time (although my poster shows that the method proposed by Ted Pincus takes 20 seconds---shameless plug--), or require labs and formulae that are not available or difficult to calculate. To make these calculations more user friendly, many have proposed alternatives to the ACR criteria or DAS28. Smolen has been using SDAI and now CDAI (which eliminates the CRP), Pincus is using the MD-HAQ and “RAPID” and now Dr. Cush has proposed another, simple measure that can be readily calculated by anyone, at the time of the office visit.
Global Arthritis Score: A Rapid Practice Tool for Rheumatoid Arthritis (RA) Assessment
PURPOSE: Validated outcome measures have been promoted to assess outcomes in RA clinical trials. However, such tools (ACR20, DAS, DAS28, HAQ-DI, MD-HAQ, SF-36, SDAI, mSDAI, etc) are seldom used in practice or clinical decision making. Reasons for their neglect include time constraints, uncommon measurements (global scores, long surveys), lab delays and complicated calculations. A recent survey of 1130 US rheumatologists revealed that only 12.2% used the HAQ and 6% calculated the disease activity score (DAS) when assessing RA. Half of US Rheums make treatment changes based on MD preferences, yet few use objective measures. This study will demonstrate the value and validity of a novel practice tool, the Global Arthritis Score (GAS), in the assessment and management of RA patients. The GAS is the sum of 3 measures: 1) patient pain (0-10 scale); 2) raw mHAQ (range 0-24; using the 8 question modified Health Assessment Questionnaire[HAQ]); and 3) tender joint count (0-28). GAS totals range from 0-62 and is easily acquired during the routine encounter. METHODS: 44 consecutive RA patients (and 181 clinic visits) form the data set used to compare and validate the GAS against the DAS28, DAS-CRP, simple disease activity index (SDAI), modified SDAI (without CRP), MD global, and swollen joint count (SJC). To be included patients had to have 2 or more visits with available data. All patients meet ACR criteria for RA diagnosis and included 7 men and 37 women with a mean age of 50 yrs and disease duration of 11.7 years. Early RA (< 3yr) comprised 25% of group. Prednisone was used in 39%; with a mean dose of 7 mg/d. Patients had an average of 2.5 prior DMARDs. Half took DMARDs and 27% took MTX at mean of 18.8 mg/wk. TNF inhibitors were used in 59% at some time. Fitness of GAS to measure both activity (variables correlated for all visits) and treatment response (change in variables over time) was assessed. RESULTS: Spearman-rank correlation coefficients from this data set showed highly significant correlations (P< ) between the GAS and other validated outcome measures when assessing disease activity. Responses over time also showed the GAS to be equal or superior to the DAS and other measures. CONCLUSIONS: These analyses demonstrate the construct validity of the Global Arthritis Score (GAS) as applied to patients in clinical practice. The GAS is rapidly acquired, incorporates simple patient measures (pain, mHAQ) and is completed and calculated at the end of the tender joint exam. The GAS can be used to assess current activity, response to therapy and as a target measure of remission or near remission (eg GAS <8). 21 21

22. RAPID3 versus DAS28 in 285 RA patients
Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM
RAPID3 versus DAS28 in 285 RA patients
Pincus, Swearingen, Bergman, Yazici. RAPID3
J Rheumatol. 35: , 2008
Reference
1. Pincus T, Sokka T. Rheum Dis Clin of North Am. 2004;30:725–751.
Spearman correlation
rho = 0.657
RAPID=Routine Assessment Patient Index Data; DAS=Disease Activity Score.

23. RAPID3 versus CDAI in 285 RA patients
Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM
RAPID3 versus CDAI in 285 RA patients
Pincus, Swearingen, Bergman, Yazici. RAPID3
J Rheumatol. 35: , 2008
Reference
1. Pincus T, Sokka T. Rheum Dis Clin of North Am. 2004;30:725–751.
Spearman correlation
rho = 0.738
RAPID=Routine Assessment Patient Index Data; CDAI=Clinical Disease Activity Index.

24. Time to Score RA Measures - Seconds
Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM
Time to Score RA Measures - Seconds
Pincus et al 2009; Arthritis Care Res. in press 24

25. 30 Incomplete Responders 63 Adequate Responders (“Controls”) MTX Start
Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM
Median Levels of all patients at initiation of Mtx and mean of 2.6-years later in: incomplete responders initiating biologic agent “control” adequate responders continuing MTX
30 Incomplete Responders
63 Adequate Responders (“Controls”)
MTX Start
Biologic Start
Follow-up (NO Biologic)
ESR 28 18 24 16
MDHAQ-Function
3.2
3.3
2.3
1.0
Pain
5.2
6.8
4.1
1.4
Patient Global
5.5
4.2
0.9
RAPID3
14.9
16.2
10.6
3.6

26. Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM
% of RA patients with abnormal measures at presentation: Evidence – not eminence – based
ESR >28 mm/Hr %
CRP > %
Rheumatoid factor positive - 69%
Anti-CCP positive - 67%
Function score >2/ %
Pain score >2/ %

27. Pincus T, et al. Rheumatology (Oxford) 47:345-349, 2008
Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM
Changes in scores (0-10) for DAS28 and RAPID3 from baseline () to endpoint ( ) in two abatacept clinical trials
AIM
DAS28
RAPID3
ATTAIN
Pincus T, et al. Rheumatology (Oxford) 47: , 2008 27

28. Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM
DAS28, CDAI and RAPID3 show similar scores, categories of high, moderate, low severity and remission, and improvement criteria responses in clinical trials of:
Leflunomide
Methotrexate
Adalimumab
Abatacept
Infliximab
Certolizumab

29. DAS28, CDAI and RAPID3 Categories
Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM
DAS28, CDAI and RAPID3 Categories
Activity level
DAS28
(0-10)
CDAI (0-76)
RAPID3 (0-30)
High - change therapy or have a good reason not to
> 5.1
> 22
> 12
Moderate - strongly consider change
6.1-12
Low - consider change
2.9-10
3.1-6
Remission
 2.6
 2.8
 3
Proposed RAPID3 categories can be used to assess patient status and efficacy of treatment. Using these categories, a RAPID3 score of suggests that therapy is working and that the patient is near remission. A RAPID3 score of suggests that the patient has low disease severity and that therapy could be changed. A RAPID3 score of denotes moderate disease severity and strongly suggests that therapy should be changed. A RAPID3 score greater than 4.1 indicates high disease severity and that therapy should be changed unless contraindicated.
Using these categories, the theoretical patient with a RAPID3 score of 6.1 has high disease severity. 29

30. RAPID3 compared to DAS28 categories in 285 RA Patients at 3 Sites
Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM
RAPID3 compared to DAS28 categories in 285 RA Patients at 3 Sites
DAS28
RAPID3 Scores
12.1–30= High Severity
6.1–12.0= Moderate Severity
3.1–6.0= Low Severity
0–3.0=Near Remission
Total
>5.1 = High Activity
37 (74%)
11 (22%)
1 (2%)
50 (17%)
3.2–5.1 = Moderate Activity
39 (43%)
27 (30%)
16 (18%)
8 (9%)
90 (32%)
2.6–3.19 = Low Activity
4 (10%)
15 (38%)
10 (25%)
11 (27%)
40 (14%)
0–2.6 = Remission
10 (10%)
18 (17%)
24 (23%)
53 (50%)
105 (37%)
90 (31%)
71 (25%)
51 (18%)
73 (26%)
285
Pincus, Swearingen, Yazici, Bergman, J Rheumatol, 35: , 2008 30

31. Patients in Each RAPID3 Category (%)
Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM
Changes in RAPID3 Scores Over 5 Years in RA Patients in Usual Care
53%
30%
13% 3%
37%
33%
17%
13%
29%
25%
27%
18%
36%
25%
18%
21%
30%
12%
28%
RAPID3 categories:
High severity (>12)
Moderate severity ( )
Low severity (3.01-6)
Near remission (3)
Patients in Each RAPID3 Category (%)
Baseline 6 mo 12 mo 24 mo 60 mo
(N=60) (N=60) (N=55) (N=56) (N=43) 31 31

32. Multi-Dimensional Health Assessment Questionnaire (MDHAQ) Page 1
Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM
Multi-Dimensional Health Assessment Questionnaire (MDHAQ) Page 1

33. Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM
HAQ Page Dressing 2. Arising 3. Eating 4. Walking Aids and devices Help from an- other person

34. HAQ & multidimensional HAQ (MDHAQ)
Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM
HAQ & multidimensional HAQ (MDHAQ)
HAQ MDHAQ
1st report
Patient completion min min
# ADL
Psych, sleep No Sleep, anxiety depression
Pain VAS 10 cm line 21 circles
Pt Global VAS 10 cm line 21 circles
Scoring templates No Yes
Index No RAPID3
RADAI self-report
joint count No Yes
MD Global No Optional

35. Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM
HAQ Page Hygiene 6. Reach 7. Grip 8. Activities Aids and devices Help from an- other person

36. 10. Recent medical history
Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM
MDHAQ: Page 2
5. Review of systems
6. Morning stiffness
7. Change in status
8. Exercise
9. Fatigue
10. Recent medical history
Demographic data
MD review

37. HAQ & multidimensional HAQ (MDHAQ)
Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM
HAQ MDHAQ
Review of Systems No 60 Symptoms
Morning stiffness No Yes
Change in status No Yes
Exercise No Yes
Fatigue No VAS
Medical history No Surgery, side effects, falls
Demographic data No Yes
Social history No Yes
MD “eyeball” 15 secs 5 secs
Time to score 42 secs 10 secs

38. Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM
Considering all the ways in which illness and health conditions may affect you at this time, please indicate below how you are doing: VERY                      VERY WELL POORLY VERY ______________________________________________ VERY WELL POORLY

39. Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM
Symptom Checklist From MDHAQ Please check (√) if you have experienced any of the following over the last month:
__Fever
Weight gain (>10 lb)
Weight loss (<10 lb)
Feeling sickly
Headaches
Unusual fatigue
Swollen glands
Loss of appetite
Skin rash or hives
Unusual bruising or bleeding
Other skin problems
Loss of hair
Dry eyes
Other eye problems
Problems with hearing
Ringing in the ears
Stuffy nose
Sores in the mouth
Dry mouth
Problems with smell or taste
__Lump in your throat
Cough
Shortness of breath
Wheezing
Pain in the chest
Heart pounding (palpitations)
Trouble swallowing
Heartburn or stomach gas
Stomach pain or cramps
Nausea
Vomiting
Constipation
Diarrhea
Dark or bloody stools
Problems with urination
Gynecologic (female) problems
Dizziness
Loss of balance
Muscle pain, aches, or cramps
Muscle weakness
__Paralysis of arms or legs
Numbness or tingling in arms/legs
Fainting spells
Swelling of hands
Swelling of ankles
Swelling in other joints
Joint pain
Back pain
Neck pain
Use of drugs not sold in stores
Smoked cigarettes
More than 2 alcoholic drinks/day
Depression - feeling blue
Anxiety - feeling nervous
Problems with thinking
Problems with memory
Problems with sleeping
Sexual problems
Burning in sex organs
Problems with social activities

40. Recent Medical History: Self-report
Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM
Recent Medical History: Self-report
Over the last 6 months have you had [please check (√)]:
No Yes An operation
No Yes Inpatient hospitalization
No Yes A new illness, accident or trauma
No Yes An important new symptom
No Yes Side effect(s) of any drug
No Yes Cigarettes regularly
No Yes Change(s) of arthritis drugs or other drugs
No Yes Change of address
No Yes Change of marital status
No Yes Change of job or work duties, quit work, retired
No Yes Change of medical insurance, Medicare, etc.
No Yes Change of primary care or other doctor
Please explain any “yes" answer below, or indicate any
other health matter that affects you:
___________________________________________________________

41. Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM
The HAQ or MDHAQ, not a joint count, lab test or X-ray, is Best Predictor in RA of…
Functional status (Pincus et al Arthritis Rheum 1984; Wolfe et al J Rheumatol 1991)
Work disability (Borg et al J Rheumatol 1991; Callahan et al J Clin Epidemiol 1992; Wolfe & Hawley J Rheumatol 1998; Fex et al J Rheumatol 1998; Sokka et al J Rheumatol 1999; Barrett et al Rheumatology 2000)
Costs (Lubeck et al Arthritis Rheum 1986)
Joint replacement surgery (Wolfe & Zwillich Arthritis Rheum 1998)
Death (Pincus et al Arthritis Rheum 1984, Ann Intern Med 1994; Wolfe et al J Rheumatol 1988, Arthritis Rheum 1994; Leigh & Fries J Rheumatol 1991; Callahan et al Arthritis Care Res 1996, 1997; Soderlin et al J Rheumatol 1998; Maiden et al Ann Rheum Dis 1999; Sokka et al Ann Rheum Dis 2004) 41

42. Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM
Mortality in Elderly Normal Finnish population (n=1523) over 5 years by non-biomedical vital signs:
a) Functional capacity (HAQ ≥1 vs. <1)
b) Pain (>40 vs. ≤40)
c) Frequency of physical exercise
Cumulative Survival
Time (years)
HAQ
▬▬ < 1
▬▬ ≥ 1
Time (years)
Pain
▬▬ ≤ 40
▬▬ > 40
Time (years)
Exercise
▬▬ ≥ 1
▬▬ < 1
▬▬ none

43. Keep It Simple Stupid Pincus and Sokka, J Rheumatol, 2009
Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM
Keep It Simple Stupid
Pincus and Sokka,
J Rheumatol, 2009

44. Complexities in assessment of patients with RA and rheumatic diseases
Theodore Pincus, MD; "Measurement in Rheumatic Diseases" 8:35 - 9:15 AM
Complexities in assessment of patients with RA and rheumatic diseases
A person with hypertension, hyperlipidemia, osteoporosis, diabetes, goes to the doctor to have a test to find out how she/he is doing.
A quantitative measure, e.g., blood pressure, lipid level, bone density, HgA1c supports clinical decisions.
No lab test is definitive in all patients with rheumatoid arthritis, and the patient tells the doctor about how she/he is doing.
Should a doctor make a clinical decision on medications without recording a quantitative score for the patient’s function and pain?