Self-assessment Tools and RA
Finding a good rheumatologist can be a challenge. Getting an appointment with a good rheumatologist can sometimes be even harder. Once you have an appointment with a doctor you really like, it seems like you would never want to miss it.
But what if you are doing well? Do you really need to see the doctor?
Are routine visits to a rheumatologist really necessary?
My rheumatologist prefers to see her patients every three months, unless you need to see her sooner due to a flare-up or something that requires immediate attention. If I’m doing well, it seems like there really isn’t much to discuss. The appointment serves to update prescriptions and have blood drawn for lab work.
Staying on a quarterly schedule makes it easier to monitor laboratory tests with a small Labcorp station right inside the office for blood draws. My previous doctor only saw me every 6 months and would give me a standing order for lab work to keep on hand for routine testing.
Screening tools I've used
Each doctor has their own routine, but one thing they each need to access is how you are doing. There are different screening tools to determine this. One of those tools is the DAS28
DAS28
One tool that can be used by the physician is the DAS28 which assesses how swollen or tender a number of 28 specific joints are. (DAS stands for Disease Activity Score.) The DAS28-ESR score incorporates the results of a laboratory test that measures inflammation, such as the erythrocyte sedimentation rate. Again, a lower score indicates less disease activity.
RAPID 3
Over the years, my two rheumatologists have used different screening tools prior to visits or sometimes none at all. One of the screening tools commonly used has been the RAPID 3 (Routine Assessment of Patient Index Data)form. The responses on this form help to establish the patient’s own assessment of disease severity. A lower score indicates less disease activity.
For a while my rheumatologist would ask me to complete the RAPID3 test before each visit while sitting in the waiting area. It doesn’t take long to fill out so it’s a very easy screening tool to administer. During the height of the COVID-19 pandemic when doctors’ visit went virtual, my doctor did not have me complete this form. Now that we are back to in-person office visits, I’m still not asked to complete the RAPID3 questionnaire.
I find this curious although not something to fret over. However, it would be nice to always have a record of how the patient thinks they are doing from visit to visit.
What the data shows
Results from a recent retrospective study published in Clinical Rheumatology suggest that the RAPID3 questionnaire could be used as a screening tool to reduce the number of outpatient doctor visits needed if a patient is doing well. Researchers examined the records of 1681 RA patients with more than 5000 combined RAPID3 and DAS28 assessments to determine how well the scores of one screening tool correlated with the other. The population of patients examined were 76% female with mean age of 60 years and a median disease duration of 4 years.1
Researchers were most interested in examining the scores of patients with low disease activity. Low disease activity was detected in 28% of the RAPID3 assessments with a 92% accuracy when compared with the correlating DAS28 score. However, high disease activity detected by the RAPID3 was only confirmed by the DAS28 in 44% of cases. Meaning, when a patient reports that they are doing well, their doctor’s clinical assessment almost always matches that of the patient. But when a patient reports that they are not doing so well, the 28 joint count assessment may miss important patient-reported outcomes that should be considered.1
What does this mean for clinical practice?
Researchers conclude that in 92% of the cases where patients score low on the RAPID3 questionnaire (low enough to suggest remission or near remission), a visit to the doctor could potentially be postponed. Using this screening tool as a pre-appointment assessment could reduce the number of outpatient visits for patients with low disease activity.1
It seems like a system such as the one proposed by the research team could potentially free up rheumatology appointment times for patients who need more clinical attention and really need to be seen more quickly. It might also help to determine which patients could more safely take advantage of virtual visits or postponed visits as long as they have the power to insist upon seeing the doctor regardless of their RAPID3 score.1
What do you think?
Would you feel comfortable using a self-assessment tool to help determine whether you could potentially postpone a visit with your rheumatologist? Would you even want to avoid the quarterly or biannual trip to the doctor’s office?
Please share your thoughts in the comments section below. I look forward to reading your stories.
Be well,
Lisa
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