title: Personalizing treatment targets in rheumatoid arthritis by using a simple prediction model.
abstract: OBJECTIVE
  To develop a personalized treatment target approach in patients with rheumatoid arthritis (RA) based on baseline risk factors for joint damage progression in combination with disease activity over time.
  
  
  METHODS
  Data were used from the Nijmegen early RA cohort. Presence or absence of anticyclic citrullinated peptide antibodies (anti-CCP), high erythrocyte sedimentation rate, and erosions were translated into 4 risk profiles: 0, 1, 2, and 3. Joint damage progression was assessed with the Ratingen score, and disease activity with the original Disease Activity Score (DAS) over 3 years. The probability for joint damage progression was calculated for each risk profile and each DAS category using logistic regression models. The probabilities were translated into personalized disease activity treatment targets.
  
  
  RESULTS
  More risk factors at baseline as well as a higher DAS level resulted in a higher probability for joint damage progression in a dose-dependent way. Low DAS corresponded with a probability of 0.0, 0.08, 0.20, and 0.58 in patients with 0, 1, 2, and 3 risk factors, respectively. Moderate DAS corresponded with a probability of 0.06 in patients with 0 risk factors and 0.35 with 1 risk factor. High DAS resulted in a probability of 0.50 with no risk factors present at baseline.
  
  
  CONCLUSIONS
  Presence of anti-CCP, acute-phase response, and erosions at baseline can be used to set individual treatment targets in RA. In patients without these risk factors, a moderate DAS as a target is sufficient, while for patients with all 3 risk factors, a low DAS is not strict enough to limit the risk for joint damage.
authors.affiliation: From the Department of Rheumatology, Radboud University Medical Centre, and the Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands.Y.M.R. de Punder, MD; T.L.Th. A. Jansen, MD, PhD; A.E. van Ede, MD, PhD; P.L.C.M. van Riel, MD, PhD, Professor of Rheumatology; J. Fransen, PhD, Department of Rheumatology, Radboud University Medical Centre; A.A. den Broeder, MD, PhD, Department of Rheumatology, Sint Maartenskliniek.
authors.forename: Yvonne M R
authors.initials: YM
authors.lastname: de Punder
authors.affiliation: From the Department of Rheumatology, Radboud University Medical Centre, and the Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands.Y.M.R. de Punder, MD; T.L.Th. A. Jansen, MD, PhD; A.E. van Ede, MD, PhD; P.L.C.M. van Riel, MD, PhD, Professor of Rheumatology; J. Fransen, PhD, Department of Rheumatology, Radboud University Medical Centre; A.A. den Broeder, MD, PhD, Department of Rheumatology, Sint Maartenskliniek.
authors.forename: Tim L Th A
authors.initials: TL
authors.lastname: Jansen
authors.affiliation: From the Department of Rheumatology, Radboud University Medical Centre, and the Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands.Y.M.R. de Punder, MD; T.L.Th. A. Jansen, MD, PhD; A.E. van Ede, MD, PhD; P.L.C.M. van Riel, MD, PhD, Professor of Rheumatology; J. Fransen, PhD, Department of Rheumatology, Radboud University Medical Centre; A.A. den Broeder, MD, PhD, Department of Rheumatology, Sint Maartenskliniek.
authors.forename: Annelies E
authors.initials: AE
authors.lastname: van Ede
authors.affiliation: From the Department of Rheumatology, Radboud University Medical Centre, and the Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands.Y.M.R. de Punder, MD; T.L.Th. A. Jansen, MD, PhD; A.E. van Ede, MD, PhD; P.L.C.M. van Riel, MD, PhD, Professor of Rheumatology; J. Fransen, PhD, Department of Rheumatology, Radboud University Medical Centre; A.A. den Broeder, MD, PhD, Department of Rheumatology, Sint Maartenskliniek.
authors.forename: Alfons A
authors.initials: AA
authors.lastname: den Broeder
authors.affiliation: From the Department of Rheumatology, Radboud University Medical Centre, and the Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands.Y.M.R. de Punder, MD; T.L.Th. A. Jansen, MD, PhD; A.E. van Ede, MD, PhD; P.L.C.M. van Riel, MD, PhD, Professor of Rheumatology; J. Fransen, PhD, Department of Rheumatology, Radboud University Medical Centre; A.A. den Broeder, MD, PhD, Department of Rheumatology, Sint Maartenskliniek.
authors.forename: Piet L C M
authors.initials: PL
authors.lastname: van Riel
authors.affiliation: From the Department of Rheumatology, Radboud University Medical Centre, and the Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands.Y.M.R. de Punder, MD; T.L.Th. A. Jansen, MD, PhD; A.E. van Ede, MD, PhD; P.L.C.M. van Riel, MD, PhD, Professor of Rheumatology; J. Fransen, PhD, Department of Rheumatology, Radboud University Medical Centre; A.A. den Broeder, MD, PhD, Department of Rheumatology, Sint Maartenskliniek. Jaap.Fransen@Radboudumc.nl.
authors.forename: Jaap
authors.initials: J
authors.lastname: Fransen
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy*; D001323:Autoantibodies / Q000097:blood; D018450:Disease Progression; D005260:Female; D033023:Foot Joints / Q000000981:diagnostic imaging; D050823:Hand Joints / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D010456:Peptides, Cyclic / Q000276:immunology; D057285:Precision Medicine; D011379:Prognosis; D011859:Radiography; D018570:Risk Assessment; D012720:Severity of Illness Index
chemical_list: D018501:Antirheumatic Agents; D001323:Autoantibodies; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide
keywords: ACUTE-PHASE REACTION; ANTICYCLIC CITRULLINATED ANTIBODIES; DISEASE ACTIVITY; JOINT EROSIONS; RHEUMATOID ARTHRITIS