TY - JOUR
T1 - Predictors of joint damage progression and stringent remission in patients with established rheumatoid arthritis in clinical remission
AU - Møller-Bisgaard, Signe
AU - Georgiadis, Stylianos
AU - Hørslev-Petersen, Kim
AU - Ejbjerg, Bo
AU - Hetland, Merete Lund
AU - Ørnbjerg, Lykke Midtbøll
AU - Glinatsi, Daniel
AU - Møller, Jakob
AU - Boesen, Mikael
AU - Stengaard-Pedersen, Kristian
AU - Madsen, Ole Rintek
AU - Jensen, Bente
AU - Villadsen, Jan Alexander
AU - Hauge, Ellen-Margrethe
AU - Bennett, Philip
AU - Hendricks, Oliver
AU - Asmussen, Karsten
AU - Kowalski, Marcin
AU - Lindegaard, Hanne
AU - Bliddal, Henning
AU - Krogh, Niels Steen
AU - Ellingsen, Torkell
AU - Nielsen, Agnete H
AU - Balding, Lone
AU - Jurik, Anne Grethe
AU - Thomsen, Henrik S
AU - Østergaard, Mikkel
PY - 2021/1
Y1 - 2021/1
N2 - OBJECTIVES: To study if clinical, radiographic and MRI markers can predict MRI and radiographic damage progression and achievement of stringent remission in patients with established RA in clinical remission followed by a targeted treatment strategy.METHODS: RA patients (DAS28-CRP <3.2, no swollen joints) receiving conventional synthetic DMARDs were randomized to conventional or MRI-targeted treat-to-target strategies with predefined algorithmic treatment escalations. Potentially predictive baseline variables were tested in multivariate logistic regression analyses.RESULTS: In the 171 patients included, baseline MRI osteitis independently predicted progression in MRI erosion [odds ratio (OR) 1.13 (95% CI 1.06, 1.22)], joint space narrowing [OR 1.15 (95% CI 1.07, 1.24)] and combined damage [OR 1.23 (95% CI 1.13, 1.37)], while tenosynovitis independently predicted MRI erosion progression [OR 1.13 (95% CI 1.03, 1.25)]. A predictor of radiographic erosion progression was age, while gender predicted progression in joint space narrowing. Following an MRI treat-to-target strategy predicted stringent remission across all remission definitions: Clinical Disease Activity Index remission OR 2.94 (95% CI 1.25, 7.52), Simplified Disease Activity Index remission OR 2.50 (95% CI 1.01, 6.66), ACR/EULAR Boolean remission OR 5.47 (95% CI 2.33, 14.13). Similarly, low tender joint count and low patient visual analogue scale pain and global independently predicted achievement of more stringent remission.CONCLUSION: Baseline MRI osteitis and tenosynovitis were independent predictors of 2 year MRI damage progression in RA patients in clinical remission, while independent predictors of radiographic damage progression were age and gender. Following an MRI treat-to-target strategy, low scores of patient-reported outcomes and low tender joint count predicted achievement of stringent remission.TRIAL REGISTRATION: ClinicalTrials.gov (https://clinicaltrials.gov), NCT01656278.
AB - OBJECTIVES: To study if clinical, radiographic and MRI markers can predict MRI and radiographic damage progression and achievement of stringent remission in patients with established RA in clinical remission followed by a targeted treatment strategy.METHODS: RA patients (DAS28-CRP <3.2, no swollen joints) receiving conventional synthetic DMARDs were randomized to conventional or MRI-targeted treat-to-target strategies with predefined algorithmic treatment escalations. Potentially predictive baseline variables were tested in multivariate logistic regression analyses.RESULTS: In the 171 patients included, baseline MRI osteitis independently predicted progression in MRI erosion [odds ratio (OR) 1.13 (95% CI 1.06, 1.22)], joint space narrowing [OR 1.15 (95% CI 1.07, 1.24)] and combined damage [OR 1.23 (95% CI 1.13, 1.37)], while tenosynovitis independently predicted MRI erosion progression [OR 1.13 (95% CI 1.03, 1.25)]. A predictor of radiographic erosion progression was age, while gender predicted progression in joint space narrowing. Following an MRI treat-to-target strategy predicted stringent remission across all remission definitions: Clinical Disease Activity Index remission OR 2.94 (95% CI 1.25, 7.52), Simplified Disease Activity Index remission OR 2.50 (95% CI 1.01, 6.66), ACR/EULAR Boolean remission OR 5.47 (95% CI 2.33, 14.13). Similarly, low tender joint count and low patient visual analogue scale pain and global independently predicted achievement of more stringent remission.CONCLUSION: Baseline MRI osteitis and tenosynovitis were independent predictors of 2 year MRI damage progression in RA patients in clinical remission, while independent predictors of radiographic damage progression were age and gender. Following an MRI treat-to-target strategy, low scores of patient-reported outcomes and low tender joint count predicted achievement of stringent remission.TRIAL REGISTRATION: ClinicalTrials.gov (https://clinicaltrials.gov), NCT01656278.
KW - MRI
KW - disease activity
KW - joint damage progression
KW - outcome research
KW - predictors
KW - remission
KW - rheumatoid arthritis
KW - treat-to-target
UR - http://www.scopus.com/inward/record.url?scp=85099428399&partnerID=8YFLogxK
U2 - 10.1093/rheumatology/keaa496
DO - 10.1093/rheumatology/keaa496
M3 - Journal article
C2 - 32929463
SN - 1462-0324
VL - 60
SP - 380
EP - 391
JO - Rheumatology
JF - Rheumatology
IS - 1
ER -