The relationship between disease activity and radiologic progression in patients with rheumatoid arthritis: A longitudinal analysis

105

Objective. To evaluate the impact of infliximab therapy on the employment status of patients with early rheumatoid arthritis (RA).Methods. Methotrexate (MTX)-naive patients with active early RA were randomly allocated to receive MTX plus placebo or MTX plus infliximab (3 mg/kg or 6 mg/kg) at weeks 0, 2, and 6 and then every 8 weeks through week 46. Data for patients younger than age 65 years were included in the analyses. A patient was categorized as employable if he or she was employed or felt well enough to work if a job were available.Results. The change in actual employment was not significantly different between patients receiving MTX plus infliximab and those receiving MTX plus placebo (0.5% versus 1.3%; P > 0.5). However, the proportion of patients whose status changed from employable at baseline to unemployable at week 54 was smaller in the group receiving MTX plus infliximab compared with that in the group receiving MTX alone (8% versus 14%; P ‫؍‬ 0.05). Patients who were treated with infliximab plus MTX had a significantly greater likelihood of improvement rather than deterioration in employability (odds ratio 2.4; P < 0.001); this likelihood was not significantly greater in patients receiving MTX alone. The proportion of employed patients who lost workdays during the trial was smaller in the MTX plus infliximab group than in the MTX-alone group (P ‫؍‬ 0.010). Conclusion. The actual employment rates among patients in the 2 treatment groups were not different. However, patients with early RA who were treated with MTX plus infliximab had a higher probability of maintaining their employability compared with those who were treated with MTX alone.

Section: Discussionsupporting

confidence: 59%

Infliximab treatment maintains employability in patients with early rheumatoid arthritis

Smolen

Han²,

Heijde

et al. 2006

105

“…However, use of such techniques would have allowed for better control for longitudinal explanatory variables such as disease activity. In the COBRA followup study, we observed that disease activity during a 6-month period was strongly predictive of radiographic progression at the end of that period (12); this finding was confirmed in another cohort study (13).…”

mentioning

confidence: 55%

Understanding the window of opportunity concept in early rheumatoid arthritis

Boers¹

2003

Self Cite

156

Axial thermal gradients play a key role in monolithic diesel particulate filters. For complete particulate regeneration, the ignition location must be near the leading edge of the diesel particulate filter. A new reduced model in terms of the capacitance‐weighted and mixing cup average temperature is formulated here using the Liapunov–Schmidt reduction technique to describe the ignition behavior and account for the axial variation. The major advantage of the reduced model is that one can neglect the details of the fine scale dynamics and focus on the large scale dynamics. This new, reduced model has the ability to accurately predict two important ignition characteristics: ignition time and ignition length. Based on the reduced model results, it is shown that the thermal dispersion [a coupling of transverse diffusion (short‐scale) and axial convection (long‐scale)] plays a dominant role on ignition. © 2007 American Institute of Chemical Engineers AIChE J, 2007

“…These criteria differ slightly from the original European League Against Rheumatism criteria, because DAS improvement from baseline is not incorporated, but are in concordance with the BeSt study design (5,55). The DAS has proven to be a prognostic marker for the prevention of joint and cartilage destruction (1,15). Although our model has not shown its value to predict prolonged and sustained suppression of disease activity, other studies have already demonstrated that early suppression of disease activity is associated with better long-term outcomes (2,15).…”

Section: Discussionmentioning

confidence: 99%

A clinical pharmacogenetic model to predict the efficacy of methotrexate monotherapy in recent‐onset rheumatoid arthritis

Wessels

Kooij

Cessie

et al. 2007

220

151

Objective. To develop a clinical pharmacogenetic model to predict the efficacy of methotrexate (MTX) in rheumatoid arthritis (RA).Methods. Two hundred five patients with newly diagnosed RA and active disease were treated with MTX (initiated at a dosage of 7.5 mg/week and increased to 15 mg/week after 4 weeks) and folic acid (1 mg/day). If the Disease Activity Score (DAS) was >2.4 at 3 months, the dosage of MTX was increased up to 25 mg/week. Twenty-four baseline variables possibly influencing disease state and drug response were selected. In addition, 17 polymorphisms in 13 genes related to the MTX mechanism of action, purine and pyrimidine synthesis, were determined. Factors were compared between responders (defined as patients with a DAS <2.4 at 6 months) and nonresponders. In case of differences, a stepwise selection procedure identified the predictors for response. A clinical score was designed by simplifying regression coefficients of the independent variables. Cutoff levels were chosen based on the clinical score, and positive and negative response rates were calculated. An evaluation of the model was performed in a second group of patients.Results. The model for MTX efficacy consisted of sex, rheumatoid factor and smoking status, the DAS, and 4 polymorphisms in the AMPD1, ATIC, ITPA, and MTHFD1 genes. This prediction model was transformed into a scoring system ranging from 0 to 11.5. Scores of <3.5 had a true positive response rate of 95%. Scores of >6 had a true negative response rate of 86%. Sixty percent of the patients were categorized as either responders or nonresponders, whereas 32% of the patients were categorized using a nongenetic model. Evaluation of the model in 38 additional patients with RA supported the results.Conclusion. This study established a model for predicting the efficacy of MTX in patients with RA. This pharmacogenetic model may lead to better-tailored initial treatment decisions in patients with RA.