title: Prognostic Factors Toward Clinically Relevant Radiographic Progression in Patients With Rheumatoid Arthritis in Clinical Practice: A Japanese Multicenter, Prospective Longitudinal Cohort Study for Achieving a Treat-to-Target Strategy.
abstract: To determine prognostic factors of clinically relevant radiographic progression (CRRP) in patients with rheumatoid arthritis (RA) in clinical practice.We performed a multicenter prospective study in Japan of biological disease-modifying antirheumatic drug (bDMARD)-naive RA patients with moderate to high disease activity treated with conventional synthetic DMARDs (csDMARDs) at study entry. We longitudinally observed 408 patients for 1 year and assessed disease activity every 3 months. CRRP was defined as yearly progression of modified total Sharp score (mTSS) > 3.0 U. We also divided the cohort into 2 groups based on disease duration (<3 vs ≥3 years) and performed a subgroup analysis.CRRP was found in 10.3% of the patients. A multiple logistic regression analysis revealed that the independent variables to predict the development of CRRP were: CRP at baseline (0.30 mg/dL increase, 95% confidence interval [CI] 1.01-1.11), time-integrated Disease Activity Score in 28 joints-erythrocyte sedimentation rate (DAS28-ESR) during the 1 year postbaseline (12.4-unit increase, 95%CI 1.17-2.59), RA typical erosion at baseline (95%CI 1.56-21.1), and the introduction of bDMARDs (95%CI 0.06-0.38). The subgroup analysis revealed that time-integrated DAS28-ESR is not a predictor whereas the introduction of bDMARDs is a significant protective factor for CRRP in RA patients with disease duration <3 years.We identified factors that could be used to predict the development of CRRP in RA patients treated with DMARDs. These variables appear to be different based on the RA patients' disease durations.
authors.affiliation: From the Unit of Translational Medicine, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences (TK,YH, S-YK, NI, KI, MT, HN, AK); Japanese Red Cross Nagasaki Genbaku Hospital, Department of Rheumatology, Nagasaki (AO, MN, TA); Department of Rheumatology, Kurume University Medical Center, Kurume (TF, MN); Zenjinkai Shimin-no-Mori Hospital, Miyazaki (TH); Department of Hematology and Rheumatology, Tohoku University Hospital, Sendai (TI, RW); Rheumatic and Collagen Disease Center, Sasebo Chuo Hospital, Sasebo (YU); Tohoku Pharmaceutical University Hospital, Sendai (TK); Yu Family Clinic, Miyagi (YT); Kurume University School of Medicine, Kurume (SH); Department of Orthopaedic Surgery, Tohoku University Hospital (HO); East Sendai Rheumatism and Internal Medicine Clinic, Sendai (TI); Osaki Citizen Hospital, Osaki (OT); NHO Nagasaki Medical Center, Omura (TM); Clinical Research Center, Nagasaki University Hospital (SS); Department of Public Health (S-YK, KA); Department of Rehabilitation Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki (TO); and Sasebo City General Hospital, Sasebo (KE), Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Koga
authors.forename: Akitomo
authors.initials: A
authors.lastname: Okada
authors.forename: Takaaki
authors.initials: T
authors.lastname: Fukuda
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Hidaka
authors.forename: Tomonori
authors.initials: T
authors.lastname: Ishii
authors.forename: Yukitaka
authors.initials: Y
authors.lastname: Ueki
authors.forename: Takao
authors.initials: T
authors.lastname: Kodera
authors.forename: Munetoshi
authors.initials: M
authors.lastname: Nakashima
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Seiyo
authors.initials: S
authors.lastname: Honda
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Horai
authors.forename: Ryu
authors.initials: R
authors.lastname: Watanabe
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Okuno
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Aramaki
authors.forename: Tomomasa
authors.initials: T
authors.lastname: Izumiyama
authors.forename: Osamu
authors.initials: O
authors.lastname: Takai
authors.forename: Taiichiro
authors.initials: T
authors.lastname: Miyashita
authors.forename: Shuntaro
authors.initials: S
authors.lastname: Sato
authors.forename: Shin-Ya
authors.initials: SY
authors.lastname: Kawashiri
authors.forename: Naoki
authors.initials: N
authors.lastname: Iwamoto
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Ichinose
authors.forename: Mami
authors.initials: M
authors.lastname: Tamai
authors.forename: Tomoki
authors.initials: T
authors.lastname: Origuchi
authors.forename: Hideki
authors.initials: H
authors.lastname: Nakamura
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Aoyagi
authors.forename: Katsumi
authors.initials: K
authors.lastname: Eguchi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kawakami
mesh_terms: D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000276:immunology; D001323:Autoantibodies / Q000097:blood; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D007564:Japan; D007596:Joints / Q000000981:diagnostic imaging; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D012306:Risk
chemical_list: D018501:Antirheumatic Agents; D001323:Autoantibodies; D002097:C-Reactive Protein