A matrix risk model for the prediction of rapid radiographic progression in patients with rheumatoid arthritis receiving different dynamic treatment strategies: post hoc analyses from the BeSt study.
OBJECTIVE
To develop a matrix model for the prediction of rapid radiographic progression (RRP) in subpopulations of patients with recent-onset rheumatoid arthritis (RA) receiving different dynamic treatment strategies.


METHODS
Data from 465 patients with recent-onset RA randomised to receive initial monotherapy or combination therapy were used. Predictors for RRP (increase in Sharp-van der Heijde score > or =5 after 1 year) were identified by multivariate logistic regression analysis. For subpopulations, the estimated risk of RRP per treatment group and the number needed to treat (NNT) were visualised in a matrix.


RESULTS
The presence of autoantibodies, baseline C-reactive protein (CRP) level, erosion score and treatment group were significant independent predictors of RRP in the matrix. Combination therapy was associated with a markedly reduced risk of RRP. The positive and negative predictive values of the matrix were 62% and 91%, respectively. The NNT with initial combination therapy to prevent one patient from RRP with monotherapy was in the range 2-3, 3-7 and 7-25 for patients with a high, intermediate and low predicted risk, respectively.


CONCLUSIONS
The matrix model visualises the risk of RRP for subpopulations of patients with recent-onset RA if treated dynamically with initial monotherapy or combination therapy. Rheumatologists might use the matrix for weighing their initial treatment choice.
Visser
K
K
Department of Rheumatology C1-R, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. k.visser@lumc.nl
Goekoop-Ruiterman
Y P M
YP
de Vries-Bouwstra
J K
JK
Ronday
H K
HK
Seys
P E H
PE
Kerstens
P J S M
PJ
Huizinga
T W J
TW
Dijkmans
B A C
BA
Allaart
C F
CF
D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000276:immunology; D001323:Autoantibodies / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D018450:Disease Progression; D004359:Drug Therapy, Combination; D004812:Epidemiologic Methods; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D000069285:Infliximab; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D010456:Peptides, Cyclic / Q000276:immunology; D011241:Prednisone / Q000627:therapeutic use; D011859:Radiography; D012217:Rheumatoid Factor / Q000097:blood
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D001323:Autoantibodies; D005938:Glucocorticoids; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide; D002097:C-Reactive Protein; D012217:Rheumatoid Factor; D000069285:Infliximab; D011241:Prednisone; D008727:Methotrexate