Predictive factors of radiological progression after 2 years of remission-steered treatment in early arthritis patients: a post hoc analysis of the IMPROVED study

Predictive factors of radiological progression after 2 years of remission-steered treatment in early arthritis patients: a post hoc analysis of the IMPROVED study

ObjectivesTo identify predictive factors of radiological progression in early arthritis patients treated by remission-steered treatment.MethodsIn the IMPROVED study, 610 patients with early rheumatoid arthritis (RA) or undifferentiated arthritis (UA) were treated with methotrexate (MTX) and a tapere...

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Veröffentlicht in:Rheumatic & musculoskeletal diseases open 2016-01, Vol.2 (1), p.e000172-e000172
Hauptverfasser: Akdemir, Gülşah, Verheul, Marije K, Heimans, Lotte, Wevers-de Boer, Kirsten V C, Goekoop-Ruiterman, Yvonne P M, van Oosterhout, Maikel, Harbers, Joop B, Bijkerk, Casper, Steup-Beekman, Gerda M, Lard, Leroy R, Huizinga, Tom W J, Trouw, Leendert A, Allaart, Cornelia F
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Early Arthritis
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container_title Rheumatic & musculoskeletal diseases open
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creator Akdemir, Gülşah
Verheul, Marije K
Heimans, Lotte
Wevers-de Boer, Kirsten V C
Goekoop-Ruiterman, Yvonne P M
van Oosterhout, Maikel
Harbers, Joop B
Bijkerk, Casper
Steup-Beekman, Gerda M
Lard, Leroy R
Huizinga, Tom W J
Trouw, Leendert A
Allaart, Cornelia F
description ObjectivesTo identify predictive factors of radiological progression in early arthritis patients treated by remission-steered treatment.MethodsIn 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)
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Patients in early remission (disease activity score (DAS) &lt;1.6 after 4 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 2 years were assessed using logistic regression analysis.ResultsMedian (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 &lt;12 weeks showed a trend.ConclusionsAfter 2 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 numbersISRCTN Register number 11916566 and EudraCT number 2006 06186-16.</description><identifier>ISSN: 2056-5933</identifier><identifier>EISSN: 2056-5933</identifier><identifier>DOI: 10.1136/rmdopen-2015-000172</identifier><identifier>PMID: 26925251</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Early Arthritis</subject><ispartof>Rheumatic &amp; musculoskeletal diseases open, 2016-01, Vol.2 (1), p.e000172-e000172</ispartof><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing</rights><rights>Copyright: 2016 Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing</rights><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b538t-bb10b211fd58b078dd1836ceb79b9f9d9e6b228c0503c8e43abb4125538ca0463</citedby><cites>FETCH-LOGICAL-b538t-bb10b211fd58b078dd1836ceb79b9f9d9e6b228c0503c8e43abb4125538ca0463</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://rmdopen.bmj.com/content/2/1/e000172.full.pdf$$EPDF$$P50$$Gbmj$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://rmdopen.bmj.com/content/2/1/e000172.full$$EHTML$$P50$$Gbmj$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27528,27529,27903,27904,53769,53771,77347,77378</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26925251$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Akdemir, Gülşah</creatorcontrib><creatorcontrib>Verheul, Marije K</creatorcontrib><creatorcontrib>Heimans, Lotte</creatorcontrib><creatorcontrib>Wevers-de Boer, Kirsten V C</creatorcontrib><creatorcontrib>Goekoop-Ruiterman, Yvonne P M</creatorcontrib><creatorcontrib>van Oosterhout, Maikel</creatorcontrib><creatorcontrib>Harbers, Joop B</creatorcontrib><creatorcontrib>Bijkerk, Casper</creatorcontrib><creatorcontrib>Steup-Beekman, Gerda M</creatorcontrib><creatorcontrib>Lard, Leroy R</creatorcontrib><creatorcontrib>Huizinga, Tom W J</creatorcontrib><creatorcontrib>Trouw, Leendert A</creatorcontrib><creatorcontrib>Allaart, Cornelia F</creatorcontrib><title>Predictive factors of radiological progression after 2 years of remission-steered treatment in early arthritis patients: a post hoc analysis of the IMPROVED study</title><title>Rheumatic &amp; musculoskeletal diseases open</title><addtitle>RMD Open</addtitle><description>ObjectivesTo identify predictive factors of radiological progression in early arthritis patients treated by remission-steered treatment.MethodsIn 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) &lt;1.6 after 4 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 2 years were assessed using logistic regression analysis.ResultsMedian (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 &lt;12 weeks showed a trend.ConclusionsAfter 2 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. 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musculoskeletal diseases open</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Akdemir, Gülşah</au><au>Verheul, Marije K</au><au>Heimans, Lotte</au><au>Wevers-de Boer, Kirsten V C</au><au>Goekoop-Ruiterman, Yvonne P M</au><au>van Oosterhout, Maikel</au><au>Harbers, Joop B</au><au>Bijkerk, Casper</au><au>Steup-Beekman, Gerda M</au><au>Lard, Leroy R</au><au>Huizinga, Tom W J</au><au>Trouw, Leendert A</au><au>Allaart, Cornelia F</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predictive factors of radiological progression after 2 years of remission-steered treatment in early arthritis patients: a post hoc analysis of the IMPROVED study</atitle><jtitle>Rheumatic &amp; musculoskeletal diseases open</jtitle><addtitle>RMD Open</addtitle><date>2016-01-01</date><risdate>2016</risdate><volume>2</volume><issue>1</issue><spage>e000172</spage><epage>e000172</epage><pages>e000172-e000172</pages><issn>2056-5933</issn><eissn>2056-5933</eissn><abstract>ObjectivesTo identify predictive factors of radiological progression in early arthritis patients treated by remission-steered treatment.MethodsIn 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) &lt;1.6 after 4 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 2 years were assessed using logistic regression analysis.ResultsMedian (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 &lt;12 weeks showed a trend.ConclusionsAfter 2 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 numbersISRCTN Register number 11916566 and EudraCT number 2006 06186-16.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>26925251</pmid><doi>10.1136/rmdopen-2015-000172</doi><oa>free_for_read</oa></addata></record>
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subjects Early Arthritis
title Predictive factors of radiological progression after 2 years of remission-steered treatment in early arthritis patients: a post hoc analysis of the IMPROVED study
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