Matrix to predict rapid radiographic progression of early rheumatoid arthritis patients from the community treated with methotrexate or leflunomide: results from the ESPOIR cohortReport as inadecuate




Matrix to predict rapid radiographic progression of early rheumatoid arthritis patients from the community treated with methotrexate or leflunomide: results from the ESPOIR cohort - Download this document for free, or read online. Document in PDF available to download.

Arthritis Research and Therapy

, 14:R249

First Online: 19 November 2012Received: 12 June 2012Revised: 11 October 2012Accepted: 06 November 2012

Abstract

IntroductionEarly rheumatoid arthritis RA patients may show rapid radiographic progression RRP despite rapid initiation of synthetic disease-modifying anti-rheumatic drugs DMARDs. The present study aimed to develop a matrix to predict risk of RRP despite early DMARD initiation in real life settings.

MethodsThe ESPOIR cohort included 813 patients from the community with early arthritis for < 6 months; 370 patients had early RA and had received methotrexate or leflunomide during the first year of follow-up. RRP was defined as an increase in the van der Heijde-modified Sharp score vSHS ≥ 5 points at 1 year. Determinants of RRP were examined first by bivariate analysis, then multivariate stepwise logistic regression analysis. A visual matrix model was then developed to predict RRP in terms of patient baseline characteristics.

ResultsWe analyzed data for 370 patients. The mean Disease Activity Score in 28 joints was 5.4 ± 1.2, 18.1% of patients had typical RA erosion on radiographs and 86.4% satisfied the 2010 criteria of the American College of Rheumatology-European League Against Rheumatism. During the first year, mean change in vSHS was 1.6 ± 5.5, and 41 patients 11.1% showed RRP. A multivariate logistic regression model enabled the development of a matrix predicting RRP in terms of baseline swollen joint count, C-reactive protein level, anti-citrullinated peptide antibodies status, and erosions seen on radiography for patients with early RA who received DMARDs.

ConclusionsThe ESPOIR matrix may be a useful clinical practice tool to identify patients with early RA at high risk of RRP despite early DMARD initiation.

AbbreviationsACPAanti-citrullinated peptide antibodies

ACRAmerican College of Rheumatology

AUCarea under the curve

CRPC-reactive protein

DMARDdisease-modifying anti-rheumatic drugs

DAS28ESR-4vdisease activity score in 28 joints-4variables, using erythrocyte sedimentation rate

ESRerythrocyte sedimentation rate

EULAREuropean League Against Rheumatism

HAQHealth Assessment Questionnaire

MTXmethotrexate

RArheumatoid arthritis

RFrheumatoid factor

ROC curvereceiver operating characteristic curve

RRPrapid radiographic progression

SDsynthetic DMARD

SDDsmallest detectable difference

TNFtumor necrosis factor

vSHSvan der Heijde-modified Sharp score

SJCswollen joint count

TJCtender joint count

TNFtumor necrosis factor.

Electronic supplementary materialThe online version of this article doi:10.1186-ar4092 contains supplementary material, which is available to authorized users.

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Author: Bruno Fautrel - Benjamin Granger - Bernard Combe - Alain Saraux - Francis Guillemin - Xavier Le Loet

Source: https://link.springer.com/







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