Clinical activity after 12 weeks of treatment with nonbiologics in early rheumatoid arthritis may predict articular destruction 2 years later.
OBJECTIVE
To investigate earlier prediction of future articular destruction in patients with early rheumatoid arthritis (RA).


METHODS
We randomly allocated patients with RA with disease duration < 2 years to different nonbiologic disease modifying antirheumatic drug (DMARD) therapies in a double-blind trial. Progression of articular destruction over the 96-week treatment period was assessed using the modified Sharp method.


RESULTS
Progression of articular destruction correlated more strongly with the American College of Rheumatology (ACR) core set measures after 12 weeks of treatment than with pretreatment values. Multiple regression analysis of data after 12 weeks yielded a correlation coefficient of 0.711. The sensitivity and specificity to predict articular destruction over the 75th percentile of the cohort were 78.6% and 84.6%, respectively. Patients who showed articular destruction over the 75th percentile of the cohort had low response to treatment at 12 weeks, and continued to have high clinical disease activity thereafter. Contrasting data were found in patients with slow progression of articular destruction.


CONCLUSIONS
In patients with early RA, ACR core set measures after 12 weeks of nonbiologic DMARD treatment may predict articular destruction 2 years later. Low response to treatment at 12 weeks and continuing high disease activity thereafter were found in patients with rapid radiological progression. These data can be used to determine the appropriateness of treatment at 12 weeks and aid the decision to introduce biologic DMARD.
Ichikawa
Yoichi
Y
Department of Rheumatic, Collagen and Allergic Diseases, St. Marianna University School of Medicine, Kawasaki, Japan.
Saito
Terunobu
T
Yamanaka
Hisasi
H
Akizuki
Masashi
M
Kondo
Hirobumi
H
Kobayashi
Shigeto
S
Oshima
Hisaji
H
Kawai
Shinichi
S
Hama
Nobuaki
N
Yamada
Hidehiro
H
Mimori
Tsuneyo
T
Amano
Koichi
K
Tanaka
Yasushi
Y
Matsuoka
Yasuo
Y
Yamamoto
Sumiki
S
Matsubara
Tsukasa
T
Murata
Norikazu
N
Asai
Tomiaki
T
Suzuki
Yasuo
Y
D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000473:pathology; D018450:Disease Progression; D004311:Double-Blind Method; D006801:Humans; D007596:Joints / Q000187:drug effects / Q000473:pathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D012044:Regression Analysis; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome
D018501:Antirheumatic Agents