Deciding on progression of joint damage in paired films of individual patients: smallest detectable difference or change

Bruynesteyn, Karin; Boers, Maarten; Kostense, Piet J.; Linden, S. ven der; Heijde, Désirée M van der

doi:10.1136/ard.2003.018457

Cited by 258 publications

(209 citation statements)

References 8 publications

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“…Both baseline radiographic damage and radiographic progression were defined as binomial variables on the basis of the smallest detectable change calculated from the scoring of radiographs between the 2 observers (SHS 1.02). Calculations for the smallest interobserver detectable change were performed as previously described (39). Patients were therefore defined as having baseline radiographic damage when their initial SHS was Ն3.5.…”

Section: Methodsmentioning

confidence: 99%

Early changes in serum type ii collagen biomarkers predict radiographic progression at one year in inflammatory arthritis patients after biologic therapy

Mullan¹,

Matthews²,

Bresnihan³

et al. 2007

Arthritis & Rheumatism

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Objective. To investigate whether short-term changes in serum biomarkers of type II collagen degradation (C2C) and types I and II collagen degradation (C1,2C), as well as the biomarker for the synthesis of type II procollagen (CPII) can predict radiographic progression at 1 year following initiation of biologic therapy in patients with inflammatory arthritis.Methods. Serum levels of biomarkers were measured at baseline and at 1, 3, 6, 9, and 12 months after initiation of biologic therapy. A composite score reflecting changes from baseline in all 3 biomarkers (⌬COL) was calculated. Associations with clinical responses according to the 28-joint count Disease Activity Score and with radiographic progression according to the modified Sharp/van der Heijde score (SHS) were assessed.Results. The 1-year increase in the SHS correlated with the 1-month change in C2C results (r ‫؍‬ 0.311, P ‫؍‬ 0.028) and the ⌬COL score (r ‫؍‬ 0.342, P ‫؍‬ 0.015). Radiographic progression was predicted by increases in serum C2C at 1 month (P ‫؍‬ 0.031). The ⌬COL score was significantly associated with 1-year radiographic progression after 1 (P ‫؍‬ 0.022), 3 (P ‫؍‬ 0.015), 6 (P ‫؍‬ 0.048), and 9 (P ‫؍‬ 0.019) months of therapy. Clinical remission was predicted by 1-month decreases in serum levels of C2C (P ‫؍‬ 0.008) and C1,2C (P ‫؍‬ 0.036). By regression analysis, 1-month changes in C2C, C1,2C, and CPII levels were independently associated with, and correctly predicted radiographic outcome in, 88% of the patients.Conclusion. Short-term changes in serum levels of collagen biomarkers following initiation of biologic therapy may better predict long-term clinical and radiographic outcomes. These collagen biomarkers may therefore be valuable new early indicators of short-term biologic treatment efficacy in clinical trials and in individual patients with inflammatory erosive arthritis.Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are forms of progressive inflammatory arthritis characterized by pain and progressive destruction of the joints. Joint destruction occurs when inflamed synovial tissue erodes and degrades adjacent cartilage and bone through the action of locally produced cytokines and metalloproteinases (1). This process can be measured by quantifying the changes in joint space narrowing and erosions that are visible on serial plain radiographs (2). Radiographic joint damage is associated with long-term functional disability (3) and is the accepted assessment tool for monitoring clinical progression and long-term response to therapy (4). Radiographic progression develops over many months and years, however, and is not suitable for assessment of treatment efficacy over short periods.

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Section: Methodsmentioning

confidence: 99%

Early changes in serum type ii collagen biomarkers predict radiographic progression at one year in inflammatory arthritis patients after biologic therapy

Mullan¹,

Matthews²,

Bresnihan³

et al. 2007

Arthritis & Rheumatism

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“…Change in van der Heijde-modified TSS (8), erosions, and JSN from baseline to 24 months or the final visit was calculated. Nonprogression at 6, 12, and 24 months was assessed at 4 levels, as follows: TSS change Յ0.0, Յ0.5, Յ3.0, and less than or equal to the smallest detectable change (SDC) (19).…”

Section: Methodsmentioning

confidence: 99%

Comparison of etanercept and methotrexate, alone and combined, in the treatment of rheumatoid arthritis: Two‐year clinical and radiographic results from the TEMPO study, a double‐blind, randomized trial

Heijde¹,

Klareskog²,

Rodríguez‐Valverde³

et al. 2006

Arthritis & Rheumatism

475

244

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Objective. To evaluate the efficacy, including radiographic changes, and safety of etanercept and methotrexate (MTX), used in combination and alone, in patients with rheumatoid arthritis (RA) in whom previous treatment with a disease-modifying antirheumatic drug other than MTX had failed.Methods. Patients with RA were treated with etanercept (25 mg subcutaneously twice weekly), oral MTX (up to 20 mg weekly), or combination therapy with etanercept plus MTX through a second year, in a double-blinded manner. Clinical response was assessed using American College of Rheumatology (ACR) criteria and the Disease Activity Score (DAS), in a modified intent-to-treat analysis with the last observation carried forward (LOCF) and in a population of completers. Radiographs of the hands, wrists, and forefeet were scored for erosions and joint space narrowing at annual intervals.Results. A total of 503 of 686 patients continued into year 2 of the study. During the 2 years, significantly fewer patients receiving combination therapy withdrew from the study (29% of the combination therapy group, 39% of the etanercept group, and 48% of the MTX group). Both the LOCF and the completer analyses yielded similar results. The ACR 20% improvement (ACR20), ACR50, and ACR70 responses and the remission rates (based on a DAS of <1.6) were significantly higher with combination therapy than with either monotherapy (P < 0.01). Similarly, improvement in disability (based on the Health Assessment Questionnaire) was greater with combination therapy (P < 0.01). The combination therapy group showed significantly less radiographic progression than did either group receiving monotherapy (P < 0.05); moreover, radiographic progression was significantly lower in the etanercept group compared with the MTX group (P < 0.05). For

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“…Intra-and interobserver reliability of quantitative PDS was estimated using calculations of intraclass correlation coefficients (ICCs). The smallest detectable change (SDC) for the radiographic score change was calculated according to a previous study (15).…”

Section: Ultrasonography and Assessmentmentioning

confidence: 99%

Radiographic prognosis of finger joint damage predicted by early alteration in synovial vascularity in patients with rheumatoid arthritis: Potential utility of power doppler sonography in clinical practice

Fukae¹,

Isobe²,

Kitano³

et al. 2011

Arthritis Care & Research

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Objective. To investigate the relationship between synovial vascularity and progression of structural bone damage in each finger joint in patients with rheumatoid arthritis (RA) and to demonstrate synovial vascularity as a potential therapeutic marker. Methods. We studied 250 metacarpophalangeal (MCP) and 250 proximal interphalangeal (PIP) joints of 25 patients with active RA who were administered adalimumab or tocilizumab. Patients were examined with clinical and laboratory assessments. Power Doppler sonography was performed at baseline and at the fourth and eighth weeks. Synovial vascularity was evaluated according to quantitative measurement. Hand and foot radiography was performed at baseline and the twentieth week. Results. Clinical indices such as the 28-joint Disease Activity Score, the Clinical Disease Activity Index, and the Simplified Disease Activity Index were significantly decreased by biologic agents. The MCP and PIP joints with no response in synovial vascularity between baseline and the eighth week (vascularity improvement of <70% at the eighth week) showed a higher risk of radiographic progression compared with responsive joints (vascularity improvement of >70% at the eighth week; relative risk 2.33-9). Radiographic progression at the twentieth week was significantly lower in responsive joints than in nonresponsive joints. Conclusion. The improvement of synovial vascularity following treatment with biologic agents led to suppression of radiographic progression of RA in each finger joint. The alteration in synovial vascularity numerically reflected therapeutic efficacy. Using vascularity as a marker to determine the most suitable therapeutic approach would be beneficial for patients with active RA.

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Deciding on progression of joint damage in paired films of individual patients: smallest detectable difference or change

Cited by 258 publications

References 8 publications

Early changes in serum type ii collagen biomarkers predict radiographic progression at one year in inflammatory arthritis patients after biologic therapy

Early changes in serum type ii collagen biomarkers predict radiographic progression at one year in inflammatory arthritis patients after biologic therapy

Comparison of etanercept and methotrexate, alone and combined, in the treatment of rheumatoid arthritis: Two‐year clinical and radiographic results from the TEMPO study, a double‐blind, randomized trial

Radiographic prognosis of finger joint damage predicted by early alteration in synovial vascularity in patients with rheumatoid arthritis: Potential utility of power doppler sonography in clinical practice

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