Routine Assessment of Patient Index Data 3 score (RAPID3) correlates well with Bath Ankylosing Spondylitis Disease Activity index (BASDAI) in the assessment of disease activity and monitoring progression of axial spondyloarthritis

Abstract

Routine Assessment of Patient Index Data 3 (RAPID3) is a composite index, very useful for assessment of disease activity of various rheumatic diseases including RA. If RAPID3 can also reliably measure disease activity in axial spondyloarthritis (axSpA), it may prove to be a practical and effective quantitative assessment tool in busy practices. We studied the association of RAPID3 with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Patients with Ankylosing Spondylitis (AS) seen from 2007 to 2012 were classified as having AS or non-radiographic axial spondyloarthritis (nr-axSpA) using modified New York criteria and Assessment of SpondyloArthritis International Society criteria, respectively. Patients with simultaneous BASDAI and RAPID3 scores were enrolled (N = 112; 105 with AS, seven with nr-axSpA). Multiple regression and nonparametric receiver operating characteristics were used. Baseline mean (SD) BASDAI and RAPID3 were 4.2 (2.5) and 3.8 (2.3), respectively. Multiple linear regressions modeled a quadratic relationship between BASDAI and RAPID3 for 321 observations in 112 patients with axSpA (1) cross-sectionally: BASDAI predicted by RAPID3 (β = 1.171; s.e. = 0.113, p < 0.001) and RAPID32 (β = −0.037; s.e. = 0.014, p = 0.011) with an adjusted R 2 of 0.676; and (2) longitudinally: BASDAI predicted by RAPID3 (β = 1.196; s.e. = 0.111, p < 0.001), RAPID32 (β = −0.042; s.e. = 0.014, p = 0.004), and visit number (β = −0.142; s.e. = 0.038, p < 0.001) with an adjusted R 2 of 0.689. RAPID3 (correctly classified) corresponded to BASDAI scores of 2, 4, and 6: 1.40 (85.8 %), 3.33 (81.9 %), and 5.43 (87.1 %), respectively. RAPID3 correlates well with BASDAI in monitoring axSpA patients (including AS) in cross-sectional and longitudinal follow-up. Since it also correlates with measures of disease activity of other rheumatic diseases including RA, RAPID3 could be an attractive measure for assessing and monitoring disease activity of several conditions seen in busy rheumatology practices.

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Correspondence to Abhijeet Danve.

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Appendix (results for ankylosing spondylitis)

Appendix (results for ankylosing spondylitis)

The following figures present results for analyses of patients with ankylosing spondylitis paralleling those in the main text for patients with axial spondyloarthritis.

Correlation between BASDAI and RAPID3

Ankylosing spondylitis

Using multiple regression, we explained variation in BASDAI in terms of RAPID3 (β = 1.176; s.e. = 0.116, p < 0.001) and the square of RAPID3 (β = −0.038; s.e. = 0.015, p = 0.011) in a cross-sectional regression model, for 303 observations in 105 patients with an adjusted R 2 of 0.678. We regressed BASDAI onto RAPID3 (β = 1.213; s.e. = 0.114, p < 0.001) and the square of RAPID3 (β = −0.044; s.e. = 0.015, p = 0.003) while controlling for visit number (β = −0.156; s.e. = 0.042, p < 0.001), for observations and patient with an adjusted R 2 of 0.691. These results are presented in Table 4 and in Fig. 4.

Table 4 Results of multiple regression models predicting BASDAI among patients with ankylosing spondylitis (N = 303)
Fig. 4
figure4

A nonparametric smoothing regression (black line; 95 % confidence band, thin dashed lines) suggested a quadratic relationship between BASDAI and RAPID3 for patients with ankylosing spondylitis, so a multiple least squares regression model of BASDAI as a quadratic function of RAPID3 and a linear function of period was fit (blue line). The same model was fit while accounting for within-patient clustering of observations and produced nearly identical results (red line)

Correlation between BASDAI and RAPID3 longitudinally over visits

Fig. 5
figure5

Individual BASDAI scores (light blue) and RAPID3 scores (pink) are plotted over the order of patient visits for patients with ankylosing spondylitis. Linear regression estimates for BASDAI over time (blue line) and RAPID3 over time (red line), along with nonparametric estimates of trend for BASDAI (blue dots) and RAPID3 (red dots), are overlaid. Both sets of estimates agree closely, with divergence only for very high visit numbers (i.e., sparse data)

Correlation among the individual items of BASDAI and RAPID 3

Fig. 6
figure6

Correlation plots of BASDAI items (blue) and RAPID3 items (red) for patients with ankylosing spondylitis showing correlations numerically and visually (darker = stronger correlation)

Cutoff scores by nonparametric ROC curves

Table 5 Results of nonparametric ROC analysis for patients with AS (N = 303)

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Danve, A., Reddy, A., Vakil-Gilani, K. et al. Routine Assessment of Patient Index Data 3 score (RAPID3) correlates well with Bath Ankylosing Spondylitis Disease Activity index (BASDAI) in the assessment of disease activity and monitoring progression of axial spondyloarthritis. Clin Rheumatol 34, 117–124 (2015). https://doi.org/10.1007/s10067-014-2827-4

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Keywords

  • Ankylosing spondylitis
  • Axial spondyloarthritis
  • Bath Ankylosing Spondylitis Disease Activity index (BASDAI)
  • Inflammatory back pain
  • Routine Assessment of Patient Index Data 3 Scores (RAPID3)
  • Seronegative spondyloarthropathy