The Department of Rheumatology established the Rheumatology Outpatient Diagnosis and Treatment Database approximately 12 years ago. Because of the importance of outcome measures (such as functional status) rather than process measures (such as sedimentation rate or hemoglobin) in providing optimal care for patients with rheumatic diseases, a number of functional outcome tools were implemented during the routine clinic visit for all rheumatology patients. These tools are based on questionnaire data, and have been well validated for many rheumatic disorders. Currently, we have demographic information, diagnosis, treatment, and functional outcome data on over 20,000 patients encompassing over 120,000 visits.

Using MEDLOG, our time-oriented database, we have the ability to extract and analyze this information to examine trends in care and more specifically to examine the functional outcome of selected patient populations. The functional outcome tools currently include the MHAQ (Modified Health Assessment Questionnaire), the RAI (Rheumatology Attitudes Index), Pain visual analog scale, and Stiffness scale. Preliminary analysis of over 600 patients with a diagnosis of Rheumatoid Arthritis shows a significant decrease in MHAQ score, RAI score, pain, and stiffness over time.

Rheumatoid Arthritis is a chronic systemic inflammatory disease that affects 1-2% of the population. The yearly costs are estimated at greater than $10,000 per person. It affects predominately woman during their working years, and is a major cause of both work disability and functional disability (estimated at 50% at 10 years). The natural history of rheumatoid arthritis followed over time is progression of disease and progression of disability, despite effective medical management. Our population results show that with proper rheumatologic care and follow up, we were able to achieve an improvement in functional status, an improvement in patient control over their disease, a decrease in pain, and a decrease in stiffness for a large population of patients with rheumatoid arthritis. These findings strongly support our success in the management of this high morbidity disease.