Predictors of joint damage progression and stringent remission in patients with established rheumatoid arthritis in clinical remission

Signe Møller-Bisgaard, Stylianos Georgiadis, Kim Hørslev-Petersen, Bo Ejbjerg, Merete Lund Hetland, Lykke Midtbøll Ørnbjerg, Daniel Glinatsi, Jakob Møller, Mikael Boesen, Kristian Stengaard-Pedersen, Ole Rintek Madsen, Bente Jensen, Jan Alexander Villadsen, Ellen-Margrethe Hauge, Philip Bennett, Oliver Hendricks, Karsten Asmussen, Marcin Kowalski, Hanne Lindegaard, Henning BliddalNiels Steen Krogh, Torkell Ellingsen, Agnete H Nielsen, Lone Balding, Anne Grethe Jurik, Henrik S Thomsen, Mikkel Østergaard

Publikation: Bidrag til tidsskriftArtikelpeer review

Abstrakt

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.

OriginalsprogEngelsk
Sider (fra-til)380-391
Antal sider12
TidsskriftRheumatology
Vol/bind60
Udgave nummer1
Tidlig onlinedato15 sep. 2020
DOI
StatusUdgivet - 5 jan. 2021

Bibliografisk note

© The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Fingeraftryk

Udforsk hvilke forskningsemner 'Predictors of joint damage progression and stringent remission in patients with established rheumatoid arthritis in clinical remission' indeholder.

Citationsformater