title: Performance of matrices developed to identify patients with early rheumatoid arthritis with rapid radiographic progression despite methotrexate therapy: an external validation study based on the ESPOIR cohort data.
abstract: BACKGROUND
  Use of prediction matrices of risk or rapid radiographic progression (RRP) for early rheumatoid arthritis (RA) in clinical practice could help to better rationalise the first line of treatment. Before use, they must be validated in populations that have not participated in their construction. The main objective is to use the ESPOIR cohort to validate the performance of 3 matrices (ASPIRE, BEST and SONORA) to predict patients at high risk of RRP at 1 year of disease despite initial treatment with methotrexate (MTX).
  
  
  METHODS
  We selected from the ESPOIR cohort 370 patients receiving MTX or leflunomide (LEF) for ≥3 months within the first year of follow-up. Patients were assessed clinically every 6 months, and structural damage progression seen on radiography was measured by the van der Heijde-modified Sharp score (vSHS) at 1 year. RRP was defined as an increase in the vSHS≥5 points during the first year.
  
  
  RESULTS
  At 1 year, the mean vSHS score was 1.7±5.0 and 46 patients had RRP. The ASPIRE matrix had only moderate validity in the ESPOIR population, with area under the receiver operating characteristic curve (AUC) <0.7. The AUC for the BEST and SONORA matrices were 0.73 and 0.76. Presence of rheumatoid factor (RF)-or anti-citrullinated protein antibodies (ACPAs) and initial structural damage were always predictive of RRP at 1 year. Disease Activity Score in 28 joints (DAS28) and C reactive protein (ASPIRE threshold) were not associated with RRP.
  
  
  CONCLUSIONS
  Matrices to identify patients at risk of RRP tested in the ESPOIR cohort seem to perform moderately. There is no matrix that shows clearly superior performance.
authors.affiliation: Université Pierre et Marie Curie (UPMC)-Paris 6, GRC 08, Pierre Louis Institute of Epidemiology and Public Health, Paris, France; Department of Biostatistics, Public Health and Medical Information, AP-HP Pitié Salpêtrière Hospital, Paris, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Granger
authors.affiliation: Department of Rheumatology , Montpellier I University; Lapeyronie Hospital , Montpellier , France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Combe
authors.affiliation: Rheumatology Department , Rouen University Hospital & INSERM U905, Institute for Research and Innovation in Biomedicine, Rouen University , Rouen , France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Le Loet
authors.affiliation: Department of Rheumatology, Brest University, La Cavale Blanche University Hospital, Brest, France; INSERM ESPRI, ERI29 Université Bretagne Occidentale, Brest, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Saraux
authors.affiliation: EA 4360 APEMAC, Lorraine University, Paris-Descartes University, Nancy, France; Faculty of Medicine, CS 50184, 54505 Vandoeuvre-lès-Nancy & Inserm, CIC-EC, CHU de Brabois, 54505 Vandoeuvre-lès-Nancy, Nancy, France.
authors.forename: Francis
authors.initials: F
authors.lastname: Guillemin
authors.affiliation: Université Pierre et Marie Curie (UPMC)-Paris 6, GRC 08, Pierre Louis Institute of Epidemiology and Public Health, Paris, France; Department of Rheumatology, Pitié Salpêtrière Hospital, Paris, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Fautrel
keywords: Early Rheumatoid Arthritis; Epidemiology; Rheumatoid Arthritis; Treatment