Prognostic factors of radiographic progression in early rheumatoid arthritis: a two year prospective study after a structured therapeutic strategy using ... View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2006-11-16

AUTHORS

R. Sanmartí, A. Gómez-Centeno, G. Ercilla, M. Larrosa, O. Viñas, I. Vazquez, J. A. Gómez-Puerta, J. Gratacós, G. Salvador, J. D. Cañete

ABSTRACT

The objective of the study was to analyze the prognostic factors of radiographic progression in a series of patients with early rheumatoid arthritis (RA) after 2 years of therapy with a structured algorithm using disease-modifying antirheumatic drugs (DMARDs) and very low doses of oral glucocorticoids. One hundred and five patients (81% female) with early RA (disease duration <2 years) treated with the same therapeutic protocol using gold salts and methotrexate in a step-up strategy, together with methylprednisolone (4 mg/day), were followed up for 2 years. The outcome variable was radiographic progression after 2 years of DMARD therapy using the modified Larsen method. Clinical, biological, immunogenetic, and radiographic data were analyzed at study entry and after 1 and 2 years of follow-up. Radiographic progression (increase of four or more units in the Larsen score) was observed in 32% of patients after 2 years of follow-up. The percentage of erosive disease increased from 18.3% at baseline to 28.9% at 12 months and 44.6% at 24 months, in spite of a significant improvement in disease activity. New erosions appeared in 33% of patients after 2 years. Several baseline parameters were associated with radiographic progression in the univariate analysis: shared epitope (SE) homozygozity, HLA-DRB*04 alleles, female gender, hemoglobin, erythrocyte sedimentation rate, and anticyclic citrullinated peptide antibodies (anti-CCP). In the multivariate analysis, female gender [odds ratio (OR) 5.5, 95% confidence interval (CI): 1.1–28.2, p = 0.04], DRB1*04 alleles (OR 3.1, 95% CI 1.1–9, p = 0.03) and, marginally, anti-CCP antibodies (OR 3.6, 95% CI 0.9–14.5, p = 0.06), were associated with progression. Female patients with both DRB1*04 alleles and anti-CCP antibodies showed the highest scores in radiographic progression. The presence, but not the titer, of anti-CCP antibodies predicted progression. The positive predictive value of the multivariate model for progression was only 53.9% whereas the negative predictive value was 80.3%. In a series of early RA patients treated with a structured algorithm using DMARDs and very low doses of glucocorticoids, radiographic progression was observed in one third of patients after 2 years. Female gender, DRB1*04 alleles (rather than the SE), and the presence of anti-CCP antibodies at baseline (independently of the titer) were the most important predictors of progression. The utility of these parameters in clinical practice is limited by their relatively low positive predictive value. More... »

PAGES

1111-1118

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s10067-006-0462-4

DOI

http://dx.doi.org/10.1007/s10067-006-0462-4

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1008906922

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/17109060


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26 schema:description The objective of the study was to analyze the prognostic factors of radiographic progression in a series of patients with early rheumatoid arthritis (RA) after 2 years of therapy with a structured algorithm using disease-modifying antirheumatic drugs (DMARDs) and very low doses of oral glucocorticoids. One hundred and five patients (81% female) with early RA (disease duration <2 years) treated with the same therapeutic protocol using gold salts and methotrexate in a step-up strategy, together with methylprednisolone (4 mg/day), were followed up for 2 years. The outcome variable was radiographic progression after 2 years of DMARD therapy using the modified Larsen method. Clinical, biological, immunogenetic, and radiographic data were analyzed at study entry and after 1 and 2 years of follow-up. Radiographic progression (increase of four or more units in the Larsen score) was observed in 32% of patients after 2 years of follow-up. The percentage of erosive disease increased from 18.3% at baseline to 28.9% at 12 months and 44.6% at 24 months, in spite of a significant improvement in disease activity. New erosions appeared in 33% of patients after 2 years. Several baseline parameters were associated with radiographic progression in the univariate analysis: shared epitope (SE) homozygozity, HLA-DRB*04 alleles, female gender, hemoglobin, erythrocyte sedimentation rate, and anticyclic citrullinated peptide antibodies (anti-CCP). In the multivariate analysis, female gender [odds ratio (OR) 5.5, 95% confidence interval (CI): 1.1–28.2, p = 0.04], DRB1*04 alleles (OR 3.1, 95% CI 1.1–9, p = 0.03) and, marginally, anti-CCP antibodies (OR 3.6, 95% CI 0.9–14.5, p = 0.06), were associated with progression. Female patients with both DRB1*04 alleles and anti-CCP antibodies showed the highest scores in radiographic progression. The presence, but not the titer, of anti-CCP antibodies predicted progression. The positive predictive value of the multivariate model for progression was only 53.9% whereas the negative predictive value was 80.3%. In a series of early RA patients treated with a structured algorithm using DMARDs and very low doses of glucocorticoids, radiographic progression was observed in one third of patients after 2 years. Female gender, DRB1*04 alleles (rather than the SE), and the presence of anti-CCP antibodies at baseline (independently of the titer) were the most important predictors of progression. The utility of these parameters in clinical practice is limited by their relatively low positive predictive value.
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33 schema:keywords CCP antibodies
34 DMARD therapy
35 DRB1
36 HLA
37 Larsen method
38 RA patients
39 activity
40 algorithm
41 alleles
42 analysis
43 anti-CCP antibodies
44 antibodies
45 anticyclic
46 antirheumatic drugs
47 arthritis
48 baseline
49 baseline parameters
50 clinical practice
51 data
52 disease
53 disease activity
54 disease-modifying antirheumatic drugs
55 doses
56 drugs
57 early RA patients
58 early rheumatoid arthritis
59 entry
60 epitope (SE) homozygozity
61 erosion
62 erosive disease
63 erythrocyte sedimentation rate
64 factors
65 female gender
66 female patients
67 gender
68 glucocorticoids
69 gold salts
70 hemoglobin
71 higher scores
72 homozygozity
73 important predictor
74 improvement
75 low doses
76 low positive predictive value
77 method
78 methotrexate
79 methylprednisolone
80 model
81 modified Larsen method
82 months
83 multivariate analysis
84 multivariate model
85 negative predictive value
86 new erosions
87 objective
88 oral glucocorticoids
89 outcome variables
90 parameters
91 patients
92 peptide antibodies
93 percentage
94 positive predictive value
95 practice
96 predictive value
97 predictors
98 presence
99 prognostic factors
100 progression
101 prospective study
102 protocol
103 radiographic data
104 radiographic progression
105 rate
106 rheumatoid arthritis
107 salt
108 same therapeutic protocol
109 scores
110 sedimentation rate
111 series
112 series of patients
113 significant improvement
114 spite
115 step
116 strategies
117 structured algorithm
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124 third
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126 titers
127 univariate analysis
128 utility
129 values
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131 year prospective study
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