OP0119 Predictors of Radiographic Progression in Early Rheumatoid Arthritis Patients Treated by An Aggressive Tight Control Regime

Abstract

BackgroundWith implementation of tight control strategies and defined treatment targets in rheumatoid arthritis (RA) care, a majority of early RA patients may reach remission and traditional predictors of joint damage might no longer be present.ObjectivesTo identify baseline parameters predictive of 2-year radiographic progression in an early RA population treated by a semi-personalized treat-to-target strategy.MethodsDMARD naïve RA patients with <2 years from first swollen joint were included in the ARCTIC study. Patients were followed for 24 months with DAS, radiographs and ultrasound (32 joints, each scored 0–3 for gray-scale (GS) and power-Doppler (PD)). Patients were treated according to an aggressive algorithm with treatment target of DAS <1.6 and SJC44=0, and in half the patients, absence of ultrasound PD signal. Patients with risk factors for progressive joint destruction (ACPA or RF positive with baseline erosions, or MRI bone marrow edema) could be escalated more aggressively to biologics. Radiographs were scored by two readers using the van der Heijde-Sharp method, with cut-off ≥1 unit change/year to be classified as progression. The SDC was 1.94 units. Potential baseline predictors were analyzed for collinearity, and remaining variables (gender, age, smoking, BMI, disease duration <3 months, ACPA, RF, tender joints, 44 SJC, ESR, total GS-score, total PD-score, patient global and radiographic joint damage) assessed by univariate logistic regression. Variables with p<0.25 from the univariate analysis were included in the multivariate model building, and a p-value of <0.05 was required to remain in the model.ResultsMean [SD] age of the 222 patients was 51.1 [13.7] years, disease duration 7.2 [5.4] months, and mean DAS 3.5 [1.2]. 63% were female, 72% RF and 82% ACPA positive. 92 (41%) had radiographic progression at 24 months, and 68% were in DAS remission at 24 months. In 16% of patients treatment was escalated more rapidly from MTX monotherapy to biologics due to baseline risk factors. Smoking, tender joints, 44 SJC, ESR, PD-score, age and gender had a univariate p-value<0.25 but did not remain in the final model. In the multivariate model, RF positivity (OR 2.27, p-value 0.022), total van der Heijde Sharp score (OR 1.08, p-value 0.017) and ultrasound GS score (OR 1.03 per unit, p-value 0.019) were independent baseline predictors for radiographic progression at 24 months (table).Table 1.Multivariate model for baseline predictors of radiographic progression at 24 months. Model corrected for age and genderBaseline variablesRadiographic progression at 24 months (n=92/222)UnivariateMultivariateOR [CI]P-valueOR [CI]P-valueUS GS-score (0–96)1.03 [1.01, 1.05]0.0051.03 [1.00, 1.05]0.019RF positivity (IgM/IgA)1.78 [0.96, 3.29]0.072.27 [1.13, 4.57]0.022Total van der Heijde Sharp score1.11 [1.06, 1.17]<0.0011.08 [1.01, 1.14]0.017ConclusionsRF positivity, radiographic joint damage and ultrasound gray-scale score were independent baseline predictors of joint damage in early RA patients treated according to an aggress...

Predicting disease progression and poor outcomes in patients with moderately active rheumatoid arthritis: a systematic review

“…A similar result was found for grey scale ultrasound (GSUS) damage scores, with two publications [one from Switzerland ( n = 377) [27] and one from the Netherlands ( n = 222) [31] in patients with moderate disease activity] reporting that baseline damage scores could significantly predict disease progression. The Swiss study assessed 22 joints (scored from 0 to 3) and used GSUS score thresholds of 18/66, 16/66 and 11/66 to define the worst 20, 30 and 50% of GSUS scores, respectively.…”

“…Data from 30 sources [7–35] were extracted. We further prioritized studies where the study population was explicitly limited to patients with moderate RA, leaving 14 prioritized sources [3, 7, 8, 10, 11, 14, 20–22, 24, 26–28, 31], and deprioritizing 16 studies [9, 12, 13, 15–19, 23, 25, 29, 30, 32–35] that had populations with mixed RA disease activity. These deprioritized studies that reported a mean DAS within the moderate range are summarized in Supplementary Table S6, available at Rheumatology Advances in Practice online.…”

“…Progression was defined as an increase of more than one point per year. In the multivariate model, RF positivity (OR, 2.27, P = 0.022), total vdHS (OR, 1.08, P = 0.017) and GSUS score (OR, 1.03 per point, P = 0.019) were independent baseline predictors of radiographic progression at 24 months [31].…”

“…Three studies examined the prognostic value of baseline vdHS score as a marker of radiographic progression [3, 8, 31]. In an American prospective observational study of 644 patients with moderate RA (95% DMARD naïve), baseline vdHS score was one of several markers that were associated with radiographic progression, as measured by changes in vdHS score at 2 years (OR, 1.01; 95% CI, 1.00, 1.01) [8].…”

“…However, in a French study of 96 patients with moderate RA, the baseline erosion score was not predictive of significant radiographic progression (vdHS score >3.0 overall) over 3 years of follow-up [3]. In a Dutch study ( n = 222; methodology described above) [31], RF positivity (OR, 2.27; P = 0.022), total vdHS (OR, 1.08; P = 0.017) and GSUS score (OR, 1.03 per point; P = 0.019) were independent baseline predictors of radiographic progression at 24 months in a multivariate model [31].…”