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Validation and relevance of Rheumatoid Arthritis Pain Scale (RAPS) in Indian (Asian) patients suffering from rheumatoid arthritis

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Abstract

Pain in RA is multifaceted and complex. Measuring instruments are inadequate. Rheumatoid Arthritis Pain Scale (RAPS) (Arthritis Care Res 45:317–323, 2001) was designed to measure pain comprehensively but has been sparsely reported. We decided to validate a suitable version for our community. Post translation (contextual), RAPS was administered (face to face interview) to 172 consenting patients of moderately severe RA (mean pain visual analogue scale (VAS) 5.4 cm) in a cross-sectional study using standard rheumatology case record form. RAPS contained 24 questions (numeric score, anchored at 0 (never) and 6 (always); range 0–144). Fifty-seven cohort patients on supervised rheumatology care were followed for 16 weeks. SPSS (v16) was used for statistical analysis, significant p < 0.05. RAPS showed good face and content validity (consensus). Construct/criterion validity was demonstrated for subclass domains and total RAPS (Cronbach’s alpha 0.91, test–retest interclass correlation (Pearson) 0.71). Fair to modest correlation (p < 0.05) was seen with swollen joint count (0.16), Indian health assessment questionnaire (0.23), medical outcome short form (SF), 36 physical score (−0.35), SF 36 mental score (−0.21) and C-reactive protein (0.25), not with pain VAS. Similar results were shown for subclass domains (physiologic, affective, sensory, cognitive), except low alpha for affective. Age, disease duration and SF 36 were significant predictors (linear regression). In factor analysis, RAPS loaded with SF 36. The standardized response mean (0.6) was equal to pain VAS and DAS 28. RAPS was found to be a valid and clinically relevant instrument for measuring pain in Indian patients suffering from RA. It merits more widespread clinical use.

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Acknowledgments

We thank the management of ARCF-CRD for this in-house PhD research project and all patients who participated in the study and its validation process. Dr S Sarmukkadam, a biostatistician, provided excellent statistical guidance and analysis. Several colleagues, namely Dr Nachiket Kulkarni, Ms Manjit Saluja and Dr N Nahar, from CRD Pune assisted in screening and enrolling patients, rheumatology examination and co-ordination of the project. Dr Anuradha Venugopalan, in charge at the lab and an immunologist, provided an invaluable assistance in carrying out the study laboratory tests.

Authors’ contributions

All the authors were involved in drafting the manuscript and approved the final version. Dr Arvind Chopra had full access to the data and takes full responsibility for the veracity of the data in the current study. Toktam Kianifard, Taghi Kianyfard and Arvind Chopra are responsible for the study concept and design. Toktam Kianifard and Arvind Chopra are responsible for the acquisition of data. Toktam Kianifard and Arvind Chopra are responsible for the analysis and interpretation of data.

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Authors and Affiliations

  1. Centre for Rheumatic Diseases, 1988 Convent St., Hermes Elegance, Camp, Pune, 411001, India

    Toktam Kianifard, Taghi Kianyfard & Arvind Chopra

  2. Savitribai Phule Pune University, Pune, India

    Toktam Kianifard

Authors
  1. Toktam Kianifard
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  2. Taghi Kianyfard
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  3. Arvind Chopra
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Correspondence to Arvind Chopra.

Appendix

Appendix

Rheumatoid Arthritis Pain Scale [19].

For each item, choose one number from 0 (never) to 6 (always) to describe how you have felt in the last week. 0 1 2 3 4 5 6

1. I would describe my pain as gnawing. (S)

2. I would describe my pain as aching . (S)

3. I would describe the word exhausting to describe my pain (A)

4. I would describe my pain as annoying. (A)

5. I’m in constant pain. (S)

6. I would describe my pain as rhythmic. (S)

7. I have swelling of at least one joint. (P)

8. I have morning stiffness of one hour or more. (P)

9. I have pain on motion of at least one joint. (P)

10. I cannot perform all the everyday tasks I normally would because of pain. (C)

11. Pain interfere with my sleep. (C)

12. I cannot decrease my pain by using methods other than taking extra medication. (C)

13. I would describe my pain as burning. (S)

14. I find that I guard my joints to reduce pain. (A)

15. I brace myself because of pain. (A)

16. My pain is throbbing in nature. (S)

17. I would describe my pain as sharp. (S)

18. I would say my pain is severe. (S)

19. I feel stiffness in my joints after rest. (P)

20. My joints feel hot. (P)

21. I feel anxious because of pain. (C)

22. I would describe my pain as tingling. (S)

23. I feel my pain is uncontrollable. (C)

24. I feel helpless to control my pain. (C)

Each question is classified into the following subclass domains: physiologic (P), affective (A), sensory discriminative (S) and cognitive (C)

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Kianifard, T., Kianyfard, T. & Chopra, A. Validation and relevance of Rheumatoid Arthritis Pain Scale (RAPS) in Indian (Asian) patients suffering from rheumatoid arthritis. Clin Rheumatol 35, 63–71 (2016). https://doi.org/10.1007/s10067-015-3071-2

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