Predictive factors of radiological progression after 2 years of remission-steered treatment in early arthritis patients: a post hoc analysis of the IMPROVED study.

Abstract

OBJECTIVES:

To identify predictive factors of radiological progression in early arthritis patients treated by remission-steered treatment.

METHODS:

In the IMPROVED study, 610 patients with early rheumatoid arthritis (RA) or undifferentiated arthritis (UA) were treated with methotrexate (MTX) and a tapered high dose of prednisone. Patients in early remission (disease activity score (DAS) <1.6 after 4 months) tapered prednisone to zero. Patients not in early remission were randomised to arm 1: MTX plus hydroxychloroquine, sulfasalazine and prednisone, or to arm 2: MTX plus adalimumab. Predictors of radiological progression (≥0.5 Sharp/van der Heijde score; SHS) after 2 years were assessed using logistic regression analysis.

RESULTS:

Median (IQR) SHS progression in 488 patients was 0 (0-0) point, without differences between RA or UA patients or between treatment arms. In only 50/488 patients, the SHS progression was ≥0.5: 33 (66%) were in the early DAS remission group, 9 (18%) in arm 1, 5 (10%) in arm 2, 3 (6%) in the outside of protocol group. Age (OR (95% CI): 1.03 (1.00 to 1.06)) and the combined presence of anticarbamylated protein antibodies (anti-CarP) and anticitrullinated protein antibodies (ACPA) (2.54 (1.16 to 5.58)) were independent predictors for SHS progression. Symptom duration <12 weeks showed a trend.

CONCLUSIONS:

After 2 years of remission steered treatment in early arthritis patients, there was limited SHS progression in only a small group of patients. Numerically, patients who had achieved early DAS remission had more SHS progression than other patients. Positivity for both anti-CarP and ACPA and age were independently associated with SHS progression.

TRIAL REGISTRATION NUMBERS:

ISRCTN Register number 11916566 and EudraCT number 2006 06186-16.

• Authors: Gülşah Akdemir, Marije K Verheul, Lotte Heimans, Kirsten V C Wevers-de Boer, Yvonne P M Goekoop-Ruiterman, Maikel van Oosterhout, Joop B Harbers, Casper Bijkerk, Gerda M Steup-Beekman, Leroy R Lard, Tom W J Huizinga, Leendert A Trouw, Cornelia F Allaart
• Journal: RMD open (RMD Open) Vol. 2 Issue 1 Pg. e000172 ( 2016) ISSN: 2056-5933 [Print] England
• PMID: 26925251 (Publication Type: Journal Article)