title: Pretreatment multi-biomarker disease activity score and radiographic progression in early RA: results from the SWEFOT trial.
abstract: OBJECTIVE
  Prediction of radiographic progression (RP) in early rheumatoid arthritis (eRA) would be very useful for optimal choice among available therapies. We evaluated a multi-biomarker disease activity (MBDA) score, based on 12 serum biomarkers as a baseline predictor for 1-year RP in eRA.
  
  
  METHODS
  Baseline disease activity score based on erythrocyte sedimentation rate (DAS28-ESR), disease activity score based on C-reactive protein (DAS28-CRP), CRP, MBDA scores and DAS28-ESR at 3 months were analysed for 235 patients with eRA from the Swedish Farmacotherapy (SWEFOT) clinical trial. RP was defined as an increase in the Van der Heijde-modified Sharp score by more than five points over 1 year. Associations between baseline disease activity measures, the MBDA score, and 1-year RP were evaluated using univariate and multivariate logistic regression, adjusted for potential confounders.
  
  
  RESULTS
  Among 235 patients with eRA, 5 had low and 29 moderate MBDA scores at baseline. None of the former and only one of the latter group (3.4%) had RP during 1 year, while the proportion of patients with RP among those with high MBDA score was 20.9% (p=0.021). Among patients with low/moderate CRP, moderate DAS28-CRP or moderate DAS28-ESR at baseline, progression occurred in 14%, 15%, 14% and 15%, respectively. MBDA score was an independent predictor of RP as a continuous (OR=1.05, 95% CI 1.02 to 1.08) and dichotomised variable (high versus low/moderate, OR=3.86, 95% CI 1.04 to 14.26).
  
  
  CONCLUSIONS
  In patients with eRA, the MBDA score at baseline was a strong independent predictor of 1-year RP. These results suggest that when choosing initial treatment in eRA the MBDA test may be clinically useful to identify a subgroup of patients at low risk of RP.
  
  
  BACKGROUND
  WHO database at the Karolinska Institute: CT20080004; and clinicaltrials.gov: NCT00764725.
authors.affiliation: Unit of Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Karolinska Institute, Stockholm, Sweden.
authors.forename: Karen
authors.initials: K
authors.lastname: Hambardzumyan
authors.affiliation: Crescendo Bioscience Inc., South San Francisco, California, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Bolce
authors.affiliation: Unit of Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Karolinska Institute, Stockholm, Sweden Rheumatology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden.
authors.forename: Saedis
authors.initials: S
authors.lastname: Saevarsdottir
authors.affiliation: Scott Cruickshank and Associates Inc., Santa Barbara, California, USA.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Cruickshank
authors.affiliation: Crescendo Bioscience Inc., South San Francisco, California, USA.
authors.forename: Eric H
authors.initials: EH
authors.lastname: Sasso
authors.affiliation: Crescendo Bioscience Inc., South San Francisco, California, USA.
authors.forename: David
authors.initials: D
authors.lastname: Chernoff
authors.affiliation: Section of Rheumatology, Institution of Clinical Sciences, University Hospital, Lund, Sweden Section of Rheumatology, Department of Medicine, Helsingborg Hospital, Helsingborg, Sweden.
authors.forename: Kristina
authors.initials: K
authors.lastname: Forslind
authors.affiliation: Section of Rheumatology, Institution of Clinical Sciences, University Hospital, Lund, Sweden Department of Orthopaedics, Institution of Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: Ingemar F
authors.initials: IF
authors.lastname: Petersson
authors.affiliation: Section of Rheumatology, Institution of Clinical Sciences, University Hospital, Lund, Sweden.
authors.forename: Pierre
authors.initials: P
authors.lastname: Geborek
authors.affiliation: Unit of Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Karolinska Institute, Stockholm, Sweden.
authors.forename: Ronald F
authors.initials: RF
authors.lastname: van Vollenhoven
mesh_terms: D054392:Adipokines / Q000378:metabolism; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000378:metabolism*; D015415:Biomarkers / Q000378:metabolism*; D002097:C-Reactive Protein / Q000378:metabolism; D000071451:Chitinase-3-Like Protein 1; D018450:Disease Progression; D004359:Drug Therapy, Combination; D004815:Epidermal Growth Factor / Q000378:metabolism; D005260:Female; D033023:Foot Joints / Q000000981:diagnostic imaging; D050823:Hand Joints / Q000000981:diagnostic imaging; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D000069285:Infliximab; D015850:Interleukin-6 / Q000378:metabolism; D037102:Lectins / Q000378:metabolism; D020738:Leptin / Q000378:metabolism; D016015:Logistic Models; D008297:Male; D020781:Matrix Metalloproteinase 1 / Q000378:metabolism; D019278:Matrix Metalloproteinase 3 / Q000378:metabolism; D008727:Methotrexate / Q000627:therapeutic use; D015999:Multivariate Analysis; D011379:Prognosis; D011859:Radiography; D047888:Receptors, Tumor Necrosis Factor, Type I / Q000378:metabolism; D052243:Resistin / Q000378:metabolism; D000685:Serum Amyloid A Protein / Q000378:metabolism; D012720:Severity of Illness Index; D012460:Sulfasalazine / Q000627:therapeutic use; D016896:Treatment Outcome; D019010:Vascular Cell Adhesion Molecule-1 / Q000378:metabolism; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism
chemical_list: D054392:Adipokines; D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D015415:Biomarkers; C084533:CHI3L1 protein, human; D000071451:Chitinase-3-Like Protein 1; C508600:IL6 protein, human; D015850:Interleukin-6; D037102:Lectins; D020738:Leptin; D047888:Receptors, Tumor Necrosis Factor, Type I; D052243:Resistin; D000685:Serum Amyloid A Protein; D019010:Vascular Cell Adhesion Molecule-1; D042461:Vascular Endothelial Growth Factor A; D012460:Sulfasalazine; D006886:Hydroxychloroquine; D004815:Epidermal Growth Factor; D002097:C-Reactive Protein; D000069285:Infliximab; C511768:MMP3 protein, human; D019278:Matrix Metalloproteinase 3; C522360:MMP1 protein, human; D020781:Matrix Metalloproteinase 1; D008727:Methotrexate
keywords: Anti-TNF; Cytokines; Disease Activity; Patient perspective; Rheumatoid Arthritis