Session Type: Abstract Submissions (ACR)
Background/Purpose: To discover the prognostic factor identifying a subgroup with clinical relevant radiographic progression (CRRP) and rapid radiographic progressoion (RRP) among rheumatoid patients successfully treated clinically with methotrexate (MTX) alone but still need additional biologics to halt radiographic progression, we compared the baseline data on initiation of MTX therapy and subsequent radiographic progression of patients.
Methods: Clinical, structural and functional outcomes of rheumatoid patients fulfilling the ACR diagnostic criteria who were successfully treated with MTX-alone (n=151) were evaluated using DAS28-4ESR, modified total Sharp score (mTSS) and modified health assessment of questionnaire (mHAQ), MMP-3, anti-CCP2 antibody and others for 3 yrs prospectively. To identify the predictor of CRRP (ΔTSS>3) or RRP (ΔTSS>5), baseline data were assessed in relation to radiographic progression using univariate logistic regression and Fisher’s test procedures.
Results: The patients (mean: age 57.7 yrs, disease duration 4.6 yrs) were with high disease activity (mean:DAS28-4ESR 5.5, CRP 2.4mg/dL) and joint destruction (mean: ΔTSS 8.3) on initiation of MTX therapy. Clinical disease activity was significantly improved yearly from baseline to 3yrs: DAS28-4ESR from 5.5±1.2 to 3.7±1.4, %DAS28 remission from 2% to 19%, mHAQ from 0.53±0.46 to 0.18±0.31, and %mHAQ remission from 16% to 60%. After 1 yr of MTX therapy, 64/ 151 (42.4%) of patients were under structural remission, 45/ 151 (29.8%) under CRRP, and 26/ 151 (17.2%) under RRP: the values remained similar 48.6%, 21.5% and 12.1%, respectively at 3 yrs. When the patients who attained structural remission were compared with those classified into CRRP or RRP, baseline CRP and MMP-3 values were significantly different (p<0.01). According to logistic regression analysis, MMP-3 levels at baseline showed most significant association with CRRP and RRP especially after 1 yr of treatment. The cut-off value of MMP-3 was calculated to be 103.7 ng/ml by using a logistic regression receiver operating characteristics (ROC) analysis. The result showed that the patients containing MMP-3 below 103.7 ng/ml were classified not to CRRP and RRP with the sensitivity of 80.0% and 90.0%, respectively; Fisher's exact test 0.0021 and 0.0011, respectively.
Conclusion: We identified basal MMP-3 level as a predictor identifying a subgroup with CRRP and RRP among the patients who appeared successfully treated with MTX-alone but still require additional treatment with biologics to halt radiographic progression.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/mmp3-as-a-predictor-identifying-a-subgroup-of-rheumatoid-patients-who-are-successfully-treated-with-methotrexate-mtx-alone-but-still-subject-to-radiographic-progression/