A Matrix Risk Model for Prediction of Radiographic Progression in Early Rheumatoid Arthritis Based on Treatment Response at 3 Months

Pooneh S. Akhavan¹, Daming Li¹, Sahar Tabatabvakili¹ and Edward C. Keystone², ¹Mount Sinai Hospital, Toronto, ON, Canada, ²University of Toronto, Toronto, ON, Canada

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: joint damage, prognostic factors and rheumatoid arthritis, treatment

Session Information

Date: Sunday, November 5, 2017

Title: Rheumatoid Arthritis – Clinical Aspects Poster I: Treatment Patterns and Response

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: The present study aimed to develop a matix to predict risk of radiographic progression in patients with early rheumatoid arthritis. The focus of this analysis was to identify a threshold for routine disease activity measures at 3 months i.e. response to initial treatment that is associated with the lower risk of future joint damage.

Methods: Using data from the PREMIER study, radiographic progression (RP) was defined as a change in modified Sharp/van der Heijde score (SHS) of ≥3.5 U/year. Patients enrolled into the control arm of the study who received methotrexate only were analyzed. Baseline characteristics and disease activity measures at 3 months were used to predict the risk of RP at 12 months. Logistic regression was used to identify the predicators and to calculate the probability of RP. Significant predicators were categorized in order to make the models more practical to use in daily practice. The results were combined into a matrix model including significant predictors of RP.

Results:

A total of 205 patients were included in this analysis with a mean (sd) baseline age 52.0 (13.1) years, disease duration 0.8 (0.8) year, 28 swollen joint count 14.7 (5.7), 28 tender joint count 17.1 (6.4), mean sharp score (MTSS) 21.4 (21.2) and CRP 4.0 (4.1). Logistic regression models identified month 3 SJC and CRP as significant predicators of radiographic damage progression at 1 year. These variables were categorized into three groups based on the variable distribution and clinical relevance. The matrix model showed that the SJC < 5 at 3 months was associated with a significantly lower damage progression rate at any given CRP category (Table-1).

	CRP at 3 months
SJC at 3 months		<1	1 – 2	>2
	< 5	0.15 (0.08, 0.27)	0.36 (0.20, 0.57)	0.50 (0.29, 0.70)
	5 – 10	0.30 (0.18, 0.46)	0.58 (0.35, 0.77)	0.70 (0.49, 0.85)
	> 10	0.35 (0.22, 0.52)	0.63 (0.42, 0.81)	0.75 (0.57, 0.87)

Conclusion: The disease activity state at 3 months has a significant impact on future radiographic damage. Patients with less than 5 swollen joints at this time point have lower risk of radiographic damage at 1 year. Further testing in other populations and with different therapies is needed to obtain a definitive risk model that will guide rheumatologists in making treatment decisions for early RA patients.

Disclosure: P. S. Akhavan, None; D. Li, None; S. Tabatabvakili, None; E. C. Keystone, Abbott Laboratories, Amgen Inc., AstraZeneca Pharmaceuticals LP, Bristol-Myers Squibb, F. Hoffmann-La Roche Inc, Janssen Inc, Lilly Pharmaceuticals, Novartis Pharmaceuticals, Pfizer Pharmaceuticals, Sanofi-Aventis, UCB, 2,Abbott Laboratories, AstraZeneca Pharma, Biotest, Bristol-Myers Squibb Company, Crescendo Bioscience, F. Hoffmann-La Roche Inc, Genentech Inc, Janssen Inc, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, UCB, 5,Amgen, Abbott Laboratories, Astrazeneca LP, Bristol-Myers Squibb Canada,, 8.

To cite this abstract in AMA style:

S. Akhavan P, Li D, Tabatabvakili S, Keystone EC. A Matrix Risk Model for Prediction of Radiographic Progression in Early Rheumatoid Arthritis Based on Treatment Response at 3 Months [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/a-matrix-risk-model-for-prediction-of-radiographic-progression-in-early-rheumatoid-arthritis-based-on-treatment-response-at-3-months/. Accessed .

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