Session Information
Date: Monday, November 6, 2017
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose:
Prognostic factors facilitate decisions on treatment and follow-up of patients with rheumatoid arthritis (RA). Rheumatologists might use factors with poor link to evidence in clinical practice. The ProgresAR project aims to 1) benchmark the use of the most commonly known prognostic factors in RA in daily clinical practice, and 2) to contrast their use with the strength of association of these factors with poor outcome.
Methods: We performed an overview of systematic reviews of factors associated with disability, mortality, remission, and radiological progression in RA. Then, a panel of rheumatologists, removed and added factors to the selection. Following, a review in matrix was carried out for each factor and outcome. In parallel, a group of 42 rheumatologists randomly selected was surveyed. The use of each factor was recorded on a Likert scale from 1 (none) to 9 (always) generating 3 categories: 1-3 under use; 4-6 intermediate and 7-9 high use.
|
Prognostic factors |
Use M (IQR) |
Radiological progression |
Disability |
Mortality |
Remission |
|
Sociodemographic data |
|||||
|
Advanced age |
5 (4) |
C |
C |
||
|
Female gender |
6 (4) |
C |
NN |
C |
|
|
Low educational level |
5 (3) |
N |
C |
||
|
Low sociocultural level |
6 (4) |
N |
N |
N |
|
|
Medical history and clinical presentation |
|||||
|
Interstitial lung disease |
8 (1) |
N |
|||
|
Very young onset |
7 (3) |
Nn |
C |
NN |
|
|
Disease duration |
8 (3) |
C |
N |
||
|
Comorbidity and toxic habits |
|||||
|
Tobacco use |
8 (2) |
C |
N |
||
|
Obesity |
6 (2) |
C |
P |
N |
|
|
Depression |
6 (3) |
N |
N |
||
|
Baseline low bone mineral density |
6 (2) |
NN |
|||
|
Cardiovascular disease or risk factors |
8 (1) |
N |
N |
||
|
Other comorbidities (infections, liver disease, chronic kidney disease …) |
8 (2) |
N |
N |
||
|
Questionnaires or indices |
|||||
|
Activity (DAS28 score, SDAI…) |
9 (1) |
N |
N |
||
|
Function (HAQ) |
7 (2) |
C |
NN |
N |
|
|
Biomarkers |
|||||
|
Rheumatoid factor |
9 (2) |
NNN |
N |
N |
|
|
Anti-citrullinated peptide antibodies (ACPA) |
9 (1) |
NNNN |
N |
NN |
|
|
Acute phase reactants |
9 (1) |
N |
N |
||
|
Calprotectin |
2 (2) |
N |
|||
|
Interleukin-2 |
1 (1) |
NN |
|||
|
Receptor Activator for Nuclear Factor K B Ligand |
1 (2) |
N |
|||
|
Vitamin D deficit |
6 (4) |
NN |
NN |
||
|
Genetic markers |
|||||
|
Shared epitope |
2 (4) |
NNN |
N |
NN |
NN |
|
Image data |
|||||
|
Ultrasound synovitis with Doppler signal |
7 (2) |
NN |
|||
|
Osteitis by magnetic resonance |
4 (4) |
NN |
|||
|
Erosions by magnetic resonance |
4 (4) |
NNN |
|||
|
Erosions by radiography |
9 (1) |
NNN |
N |
N |
|
|
Erosions by ultrasound |
7 (3) |
N |
|||
M: median; IQR: interquartile range; C: controversial; N/n: negative effect; P: positive effect. The number of letters indicates the strength of the association, from weak (N) to strong (NNNN). Lowercase (n) indicates an intermediate assessment.
Results: The reviews identified 36 prognostic factors that were further reduced to 28. The survey was completed by 42 rheumatologists. Table 1 shows, for each factor, the reported frequency of use and the strength of association with the various outcomes.
Conclusion: Rheumatoid factor, ACPA, and erosions by radiography are well recognized and strong predictors that are used frequently. Osteitis and erosions by magnetic resonance and shared epitope have good evidence but minor use. Disease duration and smoking are frequently used as prognostic factors despite weak association with outcome, similarly to activity and acute phase reactants at baseline. Subsequently, we will test whether displaying the evidence makes rheumatologists change opinions.
To cite this abstract in AMA style:
Oton-Sanchez T, Carmona L, Luján S, Royo A, Baquero JL, Muñoz-Fernandez S. How Often Do Rheumatologists Use Valid Prognostic Factors of Rheumatoid Arthritis? the Progresar Project [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/how-often-do-rheumatologists-use-valid-prognostic-factors-of-rheumatoid-arthritis-the-progresar-project/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/how-often-do-rheumatologists-use-valid-prognostic-factors-of-rheumatoid-arthritis-the-progresar-project/