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Can we prevent rapid radiological progression in patients with early rheumatoid arthritis?

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Abstract

The aim of this study is to test the performance of a matrix model to predict rapid radiological progression (RRP) in a study population of early rheumatoid arthritis (RA) or undifferentiated arthritis (UA) patients. A matrix model using baseline CRP, erosion score, autoantibody status, and initial treatment choice to predict RRP (increase ≥5 points in Sharp-van der Heijde score (SHS) in 1 year) was derived from the BeSt study where patients with active RA (1987-criteria) were treated with initial monotherapy or combination therapy, aiming at low disease activity. In the IMPROVED study, patients with early RA (2010 criteria) and UA were initially treated with methotrexate and prednisone aiming at remission. A receiver operating characteristics (ROC) curve was used to assess the discriminative value of the model to predict damage progression in the IMPROVED population. Four hundred thirty-one out of 479 patients with RA and 106/122 with UA could be categorized as high, intermediate, low, or very low risk for RRP. One patient, with a very low risk profile, showed RRP. Thirty-two other patients (5 %) showed radiological progression ≥0.5 point SHS; none had a high risk profile and 22 had a very low risk profile. The area under the curve (AUC) of the ROC curve was 0.56 (95% CI 0.45; 0.68). A matrix model predicting RRP based on risk factors identified in recent onset active RA according to the 1987-criteria performed poorly in recent onset RA (2010 criteria) and UA. It appears that known risk factors for damage progression lose their impact with early remission steered treatment, so that RRP might be considered a phenomenon of the past.

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Acknowledgments

We would like to thank all patients as well as the following rheumatologists (other than the authors) who participated in the IMPROVED study group (all locations are in The Netherlands): W.M. de Beus (Medical Center Haaglanden, Leidschendam); C. Bijkerk (Reinier de Graaf Gasthuis, Delft); M.H.W. de Bois (Medical Center Haaglanden, The Hague); M. de Buck (Medical Center Haaglanden, Leidschendam); J.A.P.M. Ewals (Haga Hospital, The Hague); R.J. Goekoop (Haga Hospital, The Hague); Y.P. Goekoop-Ruiterman; J.H.L.M. van Groenendael (Franciscus Hospital, Roosendaal); J.B. Harbers; L.R. Lard; M. van Oosterhout (Groene Hart Hospital, Gouda); N. Riyazi (Haga hospital, The Hague); A.A. Schouffoer (Haga Hospital, The Hague); P.E.H. Seys (Lievensberg hospital, Bergen op Zoom); I. Speyer (Bronovo Hospital, The Hague); G.M. Steup—Beekman; M.L. Westedt (Bronovo Hospital, The Hague). We would also like to thank all other rheumatologists and trainee rheumatologists who enrolled patients in this study and all research nurses for their contributions.

Funding

This work was supported by Abbvie. Study design, data collection and analysis, trial management, and preparation of the manuscript were performed by the authors.

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Authors and Affiliations

  1. Department of Rheumatology, Leiden University Medical Center, PO BOX 9600, 2300 RC, Leiden, Netherlands

    L. Heimans, K. V. C. Wevers-de Boer, T. W. J. Huizinga & C. F. Allaart

  2. Department of Rheumatology, Haga Hospital, The Hague, The Netherlands

    H. K. Ronday

  3. Department of Rheumatology, Medical Center Haaglanden, The Hague, The Netherlands

    G. Collée

  4. Department of Rheumatology, Admiraal de Ruyter Hospital, Goes, The Netherlands

    P. B. J. de Sonnaville

  5. Zorgsaam Department of Rheumatology, Terneuzen, The Netherlands

    B. A. M. Grillet

Authors
  1. L. Heimans
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  2. K. V. C. Wevers-de Boer
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  3. H. K. Ronday
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  4. G. Collée
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  5. P. B. J. de Sonnaville
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  6. B. A. M. Grillet
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  7. T. W. J. Huizinga
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  8. C. F. Allaart
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Corresponding author

Correspondence to L. Heimans.

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Heimans, L., Boer, K.V.C.Wd., Ronday, H.K. et al. Can we prevent rapid radiological progression in patients with early rheumatoid arthritis?. Clin Rheumatol 34, 163–166 (2015). https://doi.org/10.1007/s10067-014-2815-8

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  • DOI: https://doi.org/10.1007/s10067-014-2815-8

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