Prognostic Factors Toward Clinically Relevant Radiographic Progression in Patients with Rheumatoid Arthritis in Clinical Practice

Tomohiro Koga, Akitomo Okada, Takaaki Fukuda, Toshihiko Hidaka, Tomonori Ishii, Yukitaka Ueki, Takao Kodera, Munetoshi Nakashima, Yuichi Takahashi, Seiyo Honda, Yoshiro Horai, Ryu Watanabe, Hiroshi Okuno, Toshiyuki Aramaki, Tomomasa Izumiyama, Osamu Takai, Taiichiro Miyashita, Shuntaro Sato, Shin Ya Kawashiri, Naoki IwamotoKunihiro Ichinose, Mami Tamai, Tomoki Origuchi, Hideki Nakamura, Kiyoshi Aoyagi, Katsumi Eguchi, Atsushi Kawakami

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Abstract

To determine prognostic factors of clinically relevant radiographic progression (CRRP) in patients with rheumatoid arthritis (RA) in clinical practice. We performed a multicenter prospective study in Japan of biological disease-modifying antirheumatic drug (bDMARD)-naive RA patients with moderate to high disease activity treated with conventional synthetic DMARDs (csDMARDs) at study entry. We longitudinally observed 408 patients for 1 year and assessed disease activity every 3 months. CRRP was defined as yearly progression of modified total Sharp score (mTSS) > 3.0 U. We also divided the cohort into 2 groups based on disease duration (<3 vs ≥3 years) and performed a subgroup analysis. CRRP was found in 10.3% of the patients. A multiple logistic regression analysis revealed that the independent variables to predict the development of CRRP were: CRP at baseline (0.30 mg/dL increase, 95% confidence interval [CI] 1.01-1.11), time-integrated Disease Activity Score in 28 joints-erythrocyte sedimentation rate (DAS28-ESR) during the 1 year postbaseline (12.4-unit increase, 95%CI 1.17-2.59), RA typical erosion at baseline (95%CI 1.56-21.1), and the introduction of bDMARDs (95%CI 0.06-0.38). The subgroup analysis revealed that time-integrated DAS28-ESR is not a predictor whereas the introduction of bDMARDs is a significant protective factor for CRRP in RA patients with disease duration <3 years. We identified factors that could be used to predict the development of CRRP in RA patients treated with DMARDs. These variables appear to be different based on the RA patients' disease durations.

Original languageEnglish
Article numbere3476
JournalMedicine (United States)
Volume95
Issue number17
DOIs
Publication statusPublished - 2016 Apr 1

ASJC Scopus subject areas

  • Medicine(all)

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    Koga, T., Okada, A., Fukuda, T., Hidaka, T., Ishii, T., Ueki, Y., Kodera, T., Nakashima, M., Takahashi, Y., Honda, S., Horai, Y., Watanabe, R., Okuno, H., Aramaki, T., Izumiyama, T., Takai, O., Miyashita, T., Sato, S., Kawashiri, S. Y., ... Kawakami, A. (2016). Prognostic Factors Toward Clinically Relevant Radiographic Progression in Patients with Rheumatoid Arthritis in Clinical Practice. Medicine (United States), 95(17), [e3476]. https://doi.org/10.1097/MD.0000000000003476