Predictive factors of radiological progression after 2â
years of remission-steered treatment in early arthritis patients: a post hoc analysis of the IMPROVED study.
RMD Open
; 2(1): e000172, 2016.
Article
em En
| MEDLINE
| ID: mdl-26925251
ABSTRACT
OBJECTIVES:
To identify predictive factors of radiological progression in early arthritis patients treated by remission-steered treatment.METHODS:
In the IMPROVED study, 610 patients with early rheumatoid arthritis (RA) or undifferentiated arthritis (UA) were treated with methotrexate (MTX) and a tapered high dose of prednisone. Patients in early remission (disease activity score (DAS) <1.6 after 4â months) tapered prednisone to zero. Patients not in early remission were randomised to arm 1 MTX plus hydroxychloroquine, sulfasalazine and prednisone, or to arm 2 MTX plus adalimumab. Predictors of radiological progression (≥0.5 Sharp/van der Heijde score; SHS) after 2â years were assessed using logistic regression analysis.RESULTS:
Median (IQR) SHS progression in 488 patients was 0 (0-0) point, without differences between RA or UA patients or between treatment arms. In only 50/488 patients, the SHS progression was ≥0.5 33 (66%) were in the early DAS remission group, 9 (18%) in arm 1, 5 (10%) in arm 2, 3 (6%) in the outside of protocol group. Age (OR (95% CI) 1.03 (1.00 to 1.06)) and the combined presence of anticarbamylated protein antibodies (anti-CarP) and anticitrullinated protein antibodies (ACPA) (2.54 (1.16 to 5.58)) were independent predictors for SHS progression. Symptom duration <12â weeks showed a trend.CONCLUSIONS:
After 2â years of remission steered treatment in early arthritis patients, there was limited SHS progression in only a small group of patients. Numerically, patients who had achieved early DAS remission had more SHS progression than other patients. Positivity for both anti-CarP and ACPA and age were independently associated with SHS progression. TRIAL REGISTRATION NUMBERS ISRCTN Register number 11916566 and EudraCT number 2006 06186-16.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Tipo de estudo:
Clinical_trials
/
Guideline
/
Prognostic_studies
/
Risk_factors_studies
Idioma:
En
Revista:
RMD Open
Ano de publicação:
2016
Tipo de documento:
Article
País de afiliação:
Holanda