Prognostic Factors Toward Clinically Relevant Radiographic Progression in Patients With Rheumatoid Arthritis in Clinical Practice

Koga, Tomohiro; Okada, Akitomo; Fukuda, Takaaki; Hidaka, Toshihiko; Ishii, Tomonori; Ueki, Yukitaka; Kodera, Takao; Nakashima, Munetoshi; Takahashi, Yuichi; Honda, Seiyo; Horai, Yoshiro; Watanabe, Ryu; Okuno, Hiroshi; Aramaki, Toshiyuki; Izumiyama, Tomomasa; Takai, Osamu; Miyashita, Taiichiro; Sato, Shuntaro; Kawashiri, S.-Y.; Iwamoto, Naoki; Ichinose, Kunihiro; Tamai, Mami; Origuchi, Tomoki; Nakamura, Hideki; Aoyagi, Kiyoshi; Eguchi, Katsumi; Kawakami, Atsushi

doi:10.1097/md.0000000000003476

Cited by 15 publications

(8 citation statements)

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“…In our 2016 study [16], the interobserver reliability (as determined by the interclass correlation coefficient) was 0.97, and the smallest detectable change of mTSS in the present study was calculated as 2.96 as described [21]. Accordingly, we defined an annual increase of the mTSS >3.0 units as the development of CRRP, as was done in a previous study [22].…”

Section: Methodsmentioning

confidence: 83%

“…Using this observational cohort, we recently reported prognostic factors for CRRP in RA patients whose clinical disease activity was moderate to high at enrollment [ 16 ]. In this second investigation, we focused on the prognostic factors for CRRP in 198 RA patients who achieved remission or LDA at enrollment.…”

Section: Methodsmentioning

confidence: 99%

“…To evaluated the patients' structural damage, radiographs of each patient's hands and feet were obtained at baseline and at 1 year, and the images were evaluated by two independent rheumatologists blinded to the clinical evaluation, using the van der Heijde-mTSS system as described [ 16 , 20 ]. In our 2016 study [ 16 ], the interobserver reliability (as determined by the interclass correlation coefficient) was 0.97, and the smallest detectable change of mTSS in the present study was calculated as 2.96 as described [ 21 ]. Accordingly, we defined an annual increase of the mTSS >3.0 units as the development of CRRP, as was done in a previous study [ 22 ].…”

Section: Methodsmentioning

confidence: 99%

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Anti-citrullinated peptide antibodies are the strongest predictor of clinically relevant radiographic progression in rheumatoid arthritis patients achieving remission or low disease activity: A post hoc analysis of a nationwide cohort in Japan

et al. 2017

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ObjectivesTo determine prognostic factors of clinically relevant radiographic progression (CRRP) in patients with rheumatoid arthritis (RA) achieving remission or low disease activity (LDA) in clinical practice.MethodsUsing data from a nationwide, multicenter, prospective study in Japan, we evaluated 198 biological disease-modifying antirheumatic drug (bDMARD)-naïve RA patients who were in remission or had LDA at study entry after being treated with conventional synthetic DMARDs (csDMARDs). CRRP was defined as the yearly progression of modified total Sharp score (mTSS) >3.0 U. We performed a multiple logistic regression analysis to explore the factors to predict CRRP at 1 year. We used receiver operating characteristic (ROC) curve to estimate the performance of relevant variables for predicting CRRP.ResultsThe mean Disease Activity Score in 28 joints-erythrocyte sedimentation rate (DAS28-ESR) was 2.32 ± 0.58 at study entry. During the 1-year observation, remission or LDA persisted in 72% of the patients. CRRP was observed in 7.6% of the patients. The multiple logistic regression analysis revealed that the independent variables to predict the development of CRRP were: anti-citrullinated peptide antibodies (ACPA) positivity at baseline (OR = 15.2, 95%CI 2.64–299), time-integrated DAS28-ESR during the 1 year post-baseline (7.85-unit increase, OR = 1.83, 95%CI 1.03–3.45), and the mTSS at baseline (13-unit increase, OR = 1.22, 95%CI 1.06–1.42).ConclusionsACPA positivity was the strongest independent predictor of CRRP in patients with RA in remission or LDA. Physicians should recognize ACPA as a poor-prognosis factor regarding the radiographic outcome of RA, even among patients showing a clinically favorable response to DMARDs.

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Section: Methodsmentioning

confidence: 83%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Anti-citrullinated peptide antibodies are the strongest predictor of clinically relevant radiographic progression in rheumatoid arthritis patients achieving remission or low disease activity: A post hoc analysis of a nationwide cohort in Japan

et al. 2017

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“…Time-integrated DAS28-ESR values during the first year post baseline were assessed by Koga et al [11]. Rapid progression was the outcome and for this target, time-integrated DAS28 was not predictive.…”

Section: Value Of Prognostic Factors and Perspectivesmentioning

confidence: 99%

Poor prognostic factors guiding treatment decisions in rheumatoid arthritis patients: a review of data from randomized clinical trials and cohort studies

Albrecht

Zink

2017

Arthritis Res Ther

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Prognostic factors are used for treatment decisions in rheumatoid arthritis (RA). High disease activity, the early presence of erosions, and autoantibody positivity are the most frequently used poor prognostic factors but other features, such as functional disability, extraarticular disease, or multibiomarkers, are also assessed. Prognostic factors are incorporated in current treatment recommendations for the management of RA and are used as inclusion criteria in randomized controlled trials. They are defined heterogeneously and the relevance of a single or combined presence of poor prognostic factors remains unclear. This review summarizes the current definitions of poor prognostic factors and their use in clinical research. Perspectives on future research are also outlined.

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“…Als relevanteste Prädiktoren gelten hohe serologische Entzündungszeichen, Seropositivität (ACPA > Rheumafaktor) und früher Nachweis struktureller Schäden in der Bildgebung. Dies wurde in einer prospektiven japanischen Studie bestätigt (19). Auch wenn dieses Vorgehen logisch und sinnvoll erscheint, ist es bisher jedoch durch randomisiert kontrollierte Studien noch nicht genügend untermauert.…”

Section: Einsatz Von Bdmards Im Therapie-algorithmus Der Rheumatoidenunclassified

Aktueller Stand der Therapie der rheumatoiden Arthritis mit biologischen DMARDs

Krüger¹

2017

Arthritis und Rheuma

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ZusammenfassungBiologika werden in der Rheumatologie seit 17 Jahren eingesetzt. Sie haben die Behandlungsmöglichkeiten bei Krankheiten wie der rheumatoiden Arthritis (RA) dramatisch verbessert und entscheidend dazu beigetragen, dass heute die Remission bei dieser Erkrankung das Behandlungsziel darstellt. Gegenwärtig sind aus dieser Wirkstoffgruppe neun Substanzen für die Behandlung der RA zugelassen, fünf davon hemmen TNF-α, je eines Interleukin-1, Interleukin-6, B-Lymphozyten und die Aktivierung von T-Lymphozyten. Zusätzlich stehen aktuell drei Infliximab-Bio -similars und ein Etanercept-Biosimilar zur Verfügung. Biologika kommen bei der RA bei Patienten mit ungünstiger Prognose als Zweitlinientherapie (in der Regel im Fall einer nicht ausreichend wirksamen Starttherapie mit Methotrexat = MTX) zum Einsatz, in den übrigen Fällen sollten sie bei Versagen konventioneller DMARDs spätestens als Drittlinientherapie eingesetzt werden. Sie sollten kombiniert mit MTX verwendet werden, so-fern dieser Kombinationspartner zur Verfügung steht. Bei MTX-Kontraindikation oder -Unverträglichkeit sind einige der Substanzen auch für die Monotherapie zugelassen, die beste Wirksamkeit bieten hier Tocilizumab und in zweiter Linie Etanercept. Bei Unwirksamkeit des ersten Biologikums ist ein Switch auf eine andere Substanz aus der Gruppe oft erfolgreich.

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Prognostic Factors Toward Clinically Relevant Radiographic Progression in Patients With Rheumatoid Arthritis in Clinical Practice

Abstract: Supplemental Digital Content is available in the text

Cited by 15 publications

References 42 publications

Anti-citrullinated peptide antibodies are the strongest predictor of clinically relevant radiographic progression in rheumatoid arthritis patients achieving remission or low disease activity: A post hoc analysis of a nationwide cohort in Japan

Anti-citrullinated peptide antibodies are the strongest predictor of clinically relevant radiographic progression in rheumatoid arthritis patients achieving remission or low disease activity: A post hoc analysis of a nationwide cohort in Japan

Poor prognostic factors guiding treatment decisions in rheumatoid arthritis patients: a review of data from randomized clinical trials and cohort studies

Aktueller Stand der Therapie der rheumatoiden Arthritis mit biologischen DMARDs

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