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

Heimans, L.; Boer, K.V.C. Wevers-de; Ronday, H.K.; Collée, Gerard; Sonnaville, Peter B J de; Grillet, Bernard; Huizinga, Tom W J; Allaart, Cornelia F

doi:10.1007/s10067-014-2815-8

Cited by 8 publications

(19 citation statements)

References 6 publications

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“…Our treat-to-target, goal-directed therapy strategy, using DAS28 as the measure, was used as a guide to medical therapy, with reductions in swollen joint count and ESR. Although we did not assess longitudinal radiographs in our population, it is likely that improvement in these disease attributes, also noted in other populations, most likely accounts for the substantial reduction in radiographic progression now seen in people with RA [53]. This is a significant achievement, as progressive joint damage was previously common in RA.…”

Section: Discussionmentioning

confidence: 92%

Real world long-term impact of intensive treatment on disease activity, disability and health-related quality of life in rheumatoid arthritis

et al. 2019

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Background The emphasis on treating rheumatoid arthritis (RA) intensively reduces disease activity but its impact in routine care is uncertain. We evaluated temporal changes in disease activities and outcomes in a 10-year prospective observational cohort study of patients in routine care at one unit. Methods The Guy’s and St Thomas’ RA cohort was established in 2005. It involved most RA patients managed in this hospital. Clinical diagnoses of RA were made by rheumatologists. Patients were seen regularly in routine care. Each visit included measurement of disease activity scores for 28 joints (DAS28), health assessment questionnaire scores (HAQ) and EuroQol scores. Patients received intensive treatments targeting DAS28 remission. Results In 1693 RA patients mean DAS28 scores fell from 2005 to 15 by 11% from 4.08 (95% CI: 3.91, 4.25) in 2005 to 3.64 (3.34, 3.78); these falls were highly significant ( p < 0.001). DAS28 components: swollen joint counts fell by 32% and ESR by 24%; in contrast tender joint counts and patient global assessments showed minimal or no reductions. The reduction in DAS28 scores was predominantly between 2005 and 2010, with no falls from 2011 onwards. Associated with falls in mean DAS28s, patients achieving remission increased (18% in 2005; 27% in 2015) and the number with active disease (DAS28 > 5.1) decreased (25% in 2005; 16% in 2015). In 752 patients seen at least annually for 3 years, persisting remission (68 patients) and intermittent remission (376 patients) were associated with less disability and better health related quality of life. Over time biologic use increased, but they were used infrequently in patients in persistent remission. Conclusions Over 10 years an intensive management strategy in a routine practice setting increased combination DMARD and biologic use: disease activity levels declined; this association is in keeping with a causal relationship. Patients who achieved remission, even transiently, had better functional outcomes than patients never achieving remission. Electronic supplementary material The online version of this article (10.1186/s41927-019-0054-y) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 92%

Real world long-term impact of intensive treatment on disease activity, disability and health-related quality of life in rheumatoid arthritis

et al. 2019

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“…This large longitudinal study assessed whether, at present, ACPA‐positive RA patients are still more severely affected than ACPA‐negative RA patients, using self‐reported impairments and limitations, including functional disability and restrictions at work as outcomes. The current availability of treatment strategies to suppress inflammation drastically reduced the frequency and degree of joint damage, causing the prospects of RA patients to change substantially . Consequently, other disease outcomes have become central, and patients have rated pain, fatigue, well‐being, and independence, factors which have been studied here, as most important .…”

Section: Discussionmentioning

confidence: 99%

“…During the last decade treatment strategies have improved, and earlier treatment initiation and treat‐to‐target approaches have resulted in better disease outcomes . Especially from the year 2000 onward, early treatment with methotrexate (MTX) has become key and, at present, clinically relevant joint destruction has become infrequent . In addition, RA patients no longer have an evidently increased mortality rate .…”

Section: Introductionmentioning

confidence: 99%

Is Anti–Citrullinated Protein Antibody–Positive Rheumatoid Arthritis Still a More Severe Disease Than Anti–Citrullinated Protein Antibody–Negative Rheumatoid Arthritis? A Longitudinal Cohort Study in Rheumatoid Arthritis Patients Diagnosed From 2000 Onward

Boer

Boonen

Mil

2018

Arthritis Care & Research

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ObjectiveBecause of its association with joint destruction, anti–citrullinated protein antibody (ACPA)–positive rheumatoid arthritis (RA) is considered to be more severe than ACPA‐negative RA. Clinically relevant joint destruction is now infrequent thanks to adequate disease suppression. According to patients, important outcomes are pain, fatigue, and independence. We evaluated whether ACPA‐positive RA patients diagnosed during or after 2000 have more severe self‐reported limitations and impairments, including restrictions at work, than ACPA‐negative RA patients.MethodsA total of 492 ACPA‐positive and 450 ACPA‐negative RA patients who fulfilled the 2010 criteria and were included in the Leiden Early Arthritis Clinic cohort during or after 2000 were compared for self‐reported pain, fatigue, disease activity, general well‐being (measured by numerical rating scales), physical function (measured by the Health Assessment Questionnaire), and work restrictions, including absenteeism at baseline and during the 4‐year followup. Linear mixed models were used.ResultsAt disease presentation, ACPA‐negative patients had more severe pain, fatigue, self‐reported disease activity scores, and functional disability (P < 0.05), although absolute differences were small. During followup, ACPA‐negative patients remained somewhat more fatigued (P = 0.002), whereas other patient‐reported impairments and limitations were similar. Thirty‐eight percent of ACPA‐negative and 48% of ACPA‐positive patients reported absenteeism (P = 0.30), with median 4 days missed in both groups in the last 3 months. Also, restrictions at work among employed patients and restrictions with household work were not statistically different at baseline and during followup.ConclusionIn current rheumatology practice, ACPA‐positive RA is not more severe than ACPA‐negative RA in terms of patients’ relevant outcomes, including physical functioning and restrictions at work. This implies that efforts to further improve the disease course should be proportional to both disease subsets.

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“…Three of these studies (i.e. De Cock et al, 80 Granger et al 82 and Heimans et al 84 ) externally validated a total of seven clinical prediction models (i.e. ASPIRE CRP, 78 ASPIRE ESR, 78 BeSt, 79 ESPOIR, 69 SONORA, 57 SWEFOT 73 and Syversen 76 ).…”

Section: Types Of Included Prediction Model Studiesmentioning

confidence: 99%

“…The five included external validation studies were also performed in appropriate data sources, being either intervention trials {i.e. Hambardzumyan et al 83 (SWEFOT), Heimans et al 84…”

Section: Description Of Data Sources For the Development Of Clinical mentioning

confidence: 99%

Assessing prognosis and prediction of treatment response in early rheumatoid arthritis: systematic reviews

Archer

Everson-Hock

Hamilton

et al. 2018

Health Technol Assess

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Background Rheumatoid arthritis (RA) is a chronic, debilitating disease associated with reduced quality of life and substantial costs. It is unclear which tests and assessment tools allow the best assessment of prognosis in people with early RA and whether or not variables predict the response of patients to different drug treatments. Objective To systematically review evidence on the use of selected tests and assessment tools in patients with early RA (1) in the evaluation of a prognosis (review 1) and (2) as predictive markers of treatment response (review 2). Data sources Electronic databases (e.g. MEDLINE, EMBASE, The Cochrane Library, Web of Science Conference Proceedings; searched to September 2016), registers, key websites, hand-searching of reference lists of included studies and key systematic reviews and contact with experts. Study selection Review 1 – primary studies on the development, external validation and impact of clinical prediction models for selected outcomes in adult early RA patients. Review 2 – primary studies on the interaction between selected baseline covariates and treatment (conventional and biological disease-modifying antirheumatic drugs) on salient outcomes in adult early RA patients. Results Review 1 – 22 model development studies and one combined model development/external validation study reporting 39 clinical prediction models were included. Five external validation studies evaluating eight clinical prediction models for radiographic joint damage were also included. c-statistics from internal validation ranged from 0.63 to 0.87 for radiographic progression (different definitions, six studies) and 0.78 to 0.82 for the Health Assessment Questionnaire (HAQ). Predictive performance in external validations varied considerably. Three models [(1) Active controlled Study of Patients receiving Infliximab for the treatment of Rheumatoid arthritis of Early onset (ASPIRE) C-reactive protein (ASPIRE CRP), (2) ASPIRE erythrocyte sedimentation rate (ASPIRE ESR) and (3) Behandelings Strategie (BeSt)] were externally validated using the same outcome definition in more than one population. Results of the random-effects meta-analysis suggested substantial uncertainty in the expected predictive performance of models in a new sample of patients. Review 2 – 12 studies were identified. Covariates examined included anti-citrullinated protein/peptide anti-body (ACPA) status, smoking status, erosions, rheumatoid factor status, C-reactive protein level, erythrocyte sedimentation rate, swollen joint count (SJC), body mass index and vascularity of synovium on power Doppler ultrasound (PDUS). Outcomes examined included erosions/radiographic progression, disease activity, physical function and Disease Activity Score-28 remission. There was statistical evidence to suggest that ACPA status, SJC and PDUS status at baseline may be treatment effect modifiers, but not necessarily that they are prognostic of response for all treatments. Most of the results were subject to considerable uncertainty and were not statistically significant. Limitations The meta-analysis in review 1 was limited by the availability of only a small number of external validation studies. Studies rarely investigated the interaction between predictors and treatment. Suggested research priorities Collaborative research (including the use of individual participant data) is needed to further develop and externally validate the clinical prediction models. The clinical prediction models should be validated with respect to individual treatments. Future assessments of treatment by covariate interactions should follow good statistical practice. Conclusions Review 1 – uncertainty remains over the optimal prediction model(s) for use in clinical practice. Review 2 – in general, there was insufficient evidence that the effect of treatment depended on baseline characteristics. Study registration This study is registered as PROSPERO CRD42016042402. Funding The National Institute for Health Research Health Technology Assessment programme.

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

Cited by 8 publications

References 6 publications

Real world long-term impact of intensive treatment on disease activity, disability and health-related quality of life in rheumatoid arthritis

Real world long-term impact of intensive treatment on disease activity, disability and health-related quality of life in rheumatoid arthritis

Is Anti–Citrullinated Protein Antibody–Positive Rheumatoid Arthritis Still a More Severe Disease Than Anti–Citrullinated Protein Antibody–Negative Rheumatoid Arthritis? A Longitudinal Cohort Study in Rheumatoid Arthritis Patients Diagnosed From 2000 Onward

Assessing prognosis and prediction of treatment response in early rheumatoid arthritis: systematic reviews

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