title: Heterogeneous Disease Trajectories Explain Variable Radiographic, Function and Quality of Life Outcomes in the Canadian Early Arthritis Cohort (CATCH).
abstract: Our objective was to identify distinct trajectories of disease activity state (DAS) and assess variation in radiographic progression, function and quality of life over the first two years of early rheumatoid arthritis (ERA). The CATCH (Canadian early ArThritis CoHort) is a prospective study recruiting ERA patients from academic and community rheumatology clinics in Canada. Sequential DAS28 scores were used to identify five mutually exclusive groups in the cohort (n = 1,586) using growth-based trajectory modeling. Distinguishing baseline sociodemographic and disease variables, treatment required, and differences in radiographic progression and quality of life measures over two years were assessed. The trajectory groups are characterized as: Group 1 (20%) initial high DAS improving rapidly to remission (REM); Group 2 (21%) initial moderate DAS improving rapidly to REM; Group 3 (30%) initial moderate DAS improving gradually to low DAS; Group 4 (19%) initial high DAS improving continuously to low DAS; and Group 5 (10%) initial high DAS improving gradually only to moderate DAS. Groups differed significantly in age, sex, race, education, employment, income and presence of comorbidities. Group 5 had persistent steroid requirements and the highest biologic therapy use. Group 2 had lower odds (OR 0.22, 95%CI 0.09 to 0.58) and Group 4 higher odds (OR 1.94, 95%CI 0.90 to 4.20) of radiographic progression compared to Group 1. Group 1 had the best improvement in physical function (Health Assessment Questionnaire 1.08 (SD 0.68) units), Physical Component Score (16.4 (SD 10.2) units), Mental Component Score (9.7 (SD 12.5) units) and fatigue (4.1 (SD 3.3) units). In conclusion, distinct disease activity state trajectories explain variable outcomes in ERA. Early prediction of disease course to tailor therapy and addressing social determinants of health could optimize outcomes.
authors: Department of Medicine and Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
authors: Cheryl
authors: C
authors: Barnabe
authors: Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
authors: Ye
authors: Y
authors: Sun
authors: Department of Medicine, Universite de Sherbrooke, Sherbrooke, Quebec, Canada.
authors: Gilles
authors: G
authors: Boire
authors: Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors: Carol A
authors: CA
authors: Hitchon
authors: Rheumatic Disease Unit, Institut de Rheumatologie, Montreal, Quebec, Canada.
authors: Boulos
authors: B
authors: Haraoui
authors: Southlake Regional Health Centre, Newmarket, Ontario, Canada.
authors: J Carter
authors: JC
authors: Thorne
authors: Southlake Regional Health Centre, Newmarket, Ontario, Canada.
authors: Diane
authors: D
authors: Tin
authors: Leiden University Medical Centre, Leiden, The Netherlands.
authors: Désirée
authors: D
authors: van der Heijde
authors: University of Alabama at Birmingham, Birmingham, Alabama, United States of America.
authors: Jeffrey R
authors: JR
authors: Curtis
authors: University of British Columbia, Vancouver, British Columbia, Canada.
authors: Shahin
authors: S
authors: Jamal
authors: Western University, London, Ontario, Canada.
authors: Janet E
authors: JE
authors: Pope
authors: Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
authors: Edward C
authors: EC
authors: Keystone
authors: McGill University, Montreal, Quebec, Canada.
authors: Susan
authors: S
authors: Bartlett
authors: Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, United States of America.
authors: Vivian P
authors: VP
authors: Bykerk
mesh_terms: D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000523:psychology / Q000628:therapy*; D002170:Canada / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D011859:Radiography; D012074:Remission Induction; D011795:Surveys and Questionnaires; D016896:Treatment Outcome