title: Predictive factors of radiological progression after 2 years of remission-steered treatment in early arthritis patients: a post hoc analysis of the IMPROVED study.
abstract: OBJECTIVE
  To identify predictive factors of radiological progression in early arthritis patients treated by remission-steered treatment.
  
  
  METHODS
  In the IMPROVED study, 610 patients with early rheumatoid arthritis (RA) or undifferentiated arthritis (UA) were treated with methotrexate (MTX) and a tapered high dose of prednisone. Patients in early remission (disease activity score (DAS) <1.6 after 4 months) tapered prednisone to zero. Patients not in early remission were randomised to arm 1: MTX plus hydroxychloroquine, sulfasalazine and prednisone, or to arm 2: MTX plus adalimumab. Predictors of radiological progression (≥0.5 Sharp/van der Heijde score; SHS) after 2 years were assessed using logistic regression analysis.
  
  
  RESULTS
  Median (IQR) SHS progression in 488 patients was 0 (0-0) point, without differences between RA or UA patients or between treatment arms. In only 50/488 patients, the SHS progression was ≥0.5: 33 (66%) were in the early DAS remission group, 9 (18%) in arm 1, 5 (10%) in arm 2, 3 (6%) in the outside of protocol group. Age (OR (95% CI): 1.03 (1.00 to 1.06)) and the combined presence of anticarbamylated protein antibodies (anti-CarP) and anticitrullinated protein antibodies (ACPA) (2.54 (1.16 to 5.58)) were independent predictors for SHS progression. Symptom duration <12 weeks showed a trend.
  
  
  CONCLUSIONS
  After 2 years of remission steered treatment in early arthritis patients, there was limited SHS progression in only a small group of patients. Numerically, patients who had achieved early DAS remission had more SHS progression than other patients. Positivity for both anti-CarP and ACPA and age were independently associated with SHS progression.
  
  
  BACKGROUND
  ISRCTN Register number 11916566 and EudraCT number 2006 06186-16.
authors.affiliation: Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands.
authors.forename: Gülşah
authors.initials: G
authors.lastname: Akdemir
authors.affiliation: Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands.
authors.forename: Marije K
authors.initials: MK
authors.lastname: Verheul
authors.affiliation: Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands.
authors.forename: Lotte
authors.initials: L
authors.lastname: Heimans
authors.affiliation: Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands.
authors.forename: Kirsten V C
authors.initials: KV
authors.lastname: Wevers-de Boer
authors.affiliation: Department of Rheumatology , Haga Hospital , The Hague , The Netherlands.
authors.forename: Yvonne P M
authors.initials: YP
authors.lastname: Goekoop-Ruiterman
authors.affiliation: Department of Rheumatology , Groene Hart Hospital , Gouda , The Netherlands.
authors.forename: Maikel
authors.initials: M
authors.lastname: van Oosterhout
authors.affiliation: Department of Rheumatology , Franciscus Hospital , Roosendaal , The Netherlands.
authors.forename: Joop B
authors.initials: JB
authors.lastname: Harbers
authors.affiliation: Department of Rheumatology , Reinier de Graaf Gasthuis , Delft , The Netherlands.
authors.forename: Casper
authors.initials: C
authors.lastname: Bijkerk
authors.affiliation: Department of Rheumatology , Bronovo Hospital , The Hague , The Netherlands.
authors.forename: Gerda M
authors.initials: GM
authors.lastname: Steup-Beekman
authors.affiliation: Department of Rheumatology , Medical Center Haaglanden , Leidschendam , The Netherlands.
authors.forename: Leroy R
authors.initials: LR
authors.lastname: Lard
authors.affiliation: Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands.
authors.forename: Tom W J
authors.initials: TW
authors.lastname: Huizinga
authors.affiliation: Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands.
authors.forename: Leendert A
authors.initials: LA
authors.lastname: Trouw
authors.affiliation: Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands.
authors.forename: Cornelia F
authors.initials: CF
authors.lastname: Allaart
keywords: Ant-CCP; Autoantibodies; Early Rheumatoid Arthritis; Treatment