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| LETTER TO EDITOR |
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| Year : 2018 | Volume
: 13
| Issue : 1 | Page : 75 |
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Comment on: A comparison of 3 rheumatoid arthritis disease activity indices in routine clinical practice
Durga Prasanna Misra, Vikas Agarwal
Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| Date of Web Publication | 26-Feb-2018 |
Correspondence Address:
Dr. Durga Prasanna Misra
Department of Clinical Immunology, C-Block, 2nd Floor, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareily Road, Lucknow - 226 014, Uttar Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/injr.injr_152_17
How to cite this article:
Misra DP, Agarwal V. Comment on: A comparison of 3 rheumatoid arthritis disease activity indices in routine clinical practice. Indian J Rheumatol 2018;13:75 |
Dear Editor,
We read with great interest the recent paper by Das et al.[1] evaluating the Rapid Assessment of Patient Index Data 3 (RAPID 3) in relation to the disease activity score using 28 joints (DAS28) and Clinical Disease Activity Index (CDAI) in Indian patients with rheumatoid arthritis (RA). The present paper,[1] along with another recent article published in the journal, which had assessed the RA Disease Activity Index-5 in comparison to DAS28 and CDAI,[2] reaffirms the utility of such indices filled by patients in the management of RA in an Indian scenario. The RAPID 3 has the advantage of being filled by the patient alone without inputs from the treating physician, therefore, may help save valuable time in busy clinics, bypassing the need to perform a full 28-joint count, as the authors have themselves said.[1] In this context, it is important to emphasize that it is critical to assess disease activity in a patient with RA, and less important which index is used to do this, as long as the same index is used every time for the individual patient, with the target of therapy being attainment of either low disease activity or remission.[3]
The authors used a version of the RAPID3 in Bengali for the assessment of some of their patients.[1] This highlights another important issue in the management of RA in an Indian scenario. Validated versions of various questionnaires in different rheumatic diseases are lacking in various Indian vernaculars and attempts should be made by the Indian Rheumatology community to translate and validate commonly used patient-reported indices in different languages to enable their widespread application for Indian patients.
A deficiency in commonly used indices for the assessment of disease activity in RA in daily practice, including the RAPID 3 and the DAS28, is a lack of assessment of foot joint involvement. RA may begin with the involvement of the foot in up to a seventh of individuals with RA,[4] with about one-half of patients reporting foot involvement at some stage.[4] Involvement of feet in RA also results in a poorer quality of life.[5] The sociocultural and economic milieu in India driving use of footwear or lack thereof in different situations might result in greater stresses on the foot. Therefore, assessing foot joints may be of greater importance in Indian patients with RA and is an avenue for further research.
Therefore, the paper by Das et al.[1] is a welcome attempt to help assess the use of a patient-reported disease activity index in an Indian scenario. The authors are of the opinion that such research focusing on India-centric problems in the treatment of rheumatic diseases such as managing increasingly busy outdoor services efficiently should be encouraged.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Das A, Sarkar R, Das C, Baisya R, Bhattacharjee U, Biswas P, et al. A comparison of 3 rheumatoid arthritis disease activity indices in routine clinical practice. Indian J Rheumatol 2017;12:209-13.  [Full text] |
| 2. | Singh H, Tanwar VS, Sukhija G, Mathur R, Kaur P. Rheumatoid arthritis disease activity index-5: Utility in busy clinical settings. Indian J Rheumatol 2017;12:72-5. [Full text] |
| 3. | Parida JR, Misra DP, Wakhlu A, Agarwal V. Is non-biological treatment of rheumatoid arthritis as good as biologics? World J Orthop 2015;6:278-83. [ PUBMED] |
| 4. | Borman P, Ayhan F, Tuncay F, Sahin M. Foot problems in a group of patients with rheumatoid arthritis: An unmet need for foot care. Open Rheumatol J 2012;6:290-5. [ PUBMED] |
| 5. | Wickman AM, Pinzur MS, Kadanoff R, Juknelis D. Health-related quality of life for patients with rheumatoid arthritis foot involvement. Foot Ankle Int 2004;25:19-26. |
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