Modified Disease Activity Score at 3 Months Is a Significant Predictor for Rapid Radiographic Progression at 12 Months Compared With Other Measures in Patients With Rheumatoid Arthritis

Abstract

Objective Progressive rheumatoid arthritis (RA) is responsible for joint damage causing disabilities, but there is no agreement on which disease measures best predict radiographic progression. We aimed to determine which disease activity measures, including the disease activity score, the modified disease activity score in 28 joints with C‐reactive protein testing (M‐DAS28‐CRP), the Clinical Disease Activity Index, and the Health Assessment Questionnaire Disability Index, at baseline and 3 months best predicted rapid radiographic progression (RRP) in patients with early RA. Methods Data were used from PREMIER, a 2‐year, multicenter, double‐blind, active comparator controlled study with methotrexate (MTX)–naïve patients with RA and active disease for less than 3 years. Treatments included adalimumab plus oral MTX, adalimumab, or oral MTX. Only patients in the MTX arm were analyzed in this study. RRP was defined as a change in the modified total Sharp score of less than 3.5 at month 12. The logistic regression analysis assessed the impact of measures at baseline and 3 months on RRP at 12 months. Best cutoff points of the M‐DAS28‐CRP were also estimated by using area under the receiver operating characteristic curve. Results A total of 149 patients were included (female patients: n = 113 [75.8%]; positive rheumatoid factor: n = 127 [85.2%]; mean [SD] age: 52.9 [13.3] years; mean [SD] disease duration: 0.8 [0.9] year; mean [SD] M‐DAS28‐CRP: 6.3 [0.9]). After adjusting for potential confounders, only the M‐DAS28‐CRP at baseline (adjusted odds ratio [AOR] = 3.29; 95% confidence interval [CI]: 1.70‐6.36) and 3 months (AOR = 2.56; 95% CI: 1.43‐4.56) strongly predicted RRP at 12 months. M‐DAS28‐CRP of 4.5 and 2.6 at baseline and 3 months, respectively, maximized positive and negative predictive values for prediction of RRP. Conclusion The M‐DAS28‐CRP was a stronger predictor at baseline and 3 months for RRP compared with other disease activity measures. Removing tender joint count and patient global assessment from the DAS28‐CRP improves prediction of RRP.

Benefit of Filgotinib, a JAK1 Preferential Inhibitor, in Rheumatoid Arthritis Patients with Previous Rapid Radiographic Progression: Post Hoc Analysis of Two Trials

“…A publication by Movahedi et al. [ 22 ] showed that modified-DAS28(CRP) (calculated with only CRP, swollen joint count 28, and PhGA components)[ 23 ] was a stronger predictor of RRP in RA patients treated with MTX. This may mean that physician judgment is another important factor of predicting radiographic progression.…”

Assessing the risk of rapid radiographic progression in Hungarian rheumatoid arthritis patients

“…Certainly, there have been other models that estimated RRP. For example, in various studies, 3-month DAS [8], anti-neutrophil cytoplasmic antibodies [9], various cartilage and proteoglycan turnover biomarkers [10], matrix metalloproteinases [11,12], some genetic markers including tumor necrosis factor α (TNF-α) gene polymorphisms [11] have been suggested as predictors of RRP. Moreover, early MRI bone edema [13] and first-year radiographic progression determined further progression in early RA [14].…”