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, 14 (6), R249

Matrix to Predict Rapid Radiographic Progression of Early Rheumatoid Arthritis Patients From the Community Treated With Methotrexate or Leflunomide: Results From the ESPOIR Cohort

Matrix to Predict Rapid Radiographic Progression of Early Rheumatoid Arthritis Patients From the Community Treated With Methotrexate or Leflunomide: Results From the ESPOIR Cohort

Bruno Fautrel et al. Arthritis Res Ther.

Abstract

Introduction: Early 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.

Methods: The 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.

Results: We 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.

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

Figures

Figure 1
Figure 1
ESPOIR prediction matrix. ESPOIR prediction matrix for use in daily practice in assessing the risk of rapid radiographic progression (RRP; change in vSHS ≥ 5 points at 1 year) in patients with early rheumatoid arthritis in terms of baseline characteristics. ACPA, anti-citrullinated protein antibody; CRP, C-reactive protein (mg/L); vSHS, van der Heijde-modified Sharp score.

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