Ellen Margrethe Hauge

Predictors of joint damage progression and stringent remission in patients with established rheumatoid arthritis in clinical remission

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

  • Signe Møller-Bisgaard, c Center for Rheumatology and Spine Diseases , Copenhagen Center for Arthritis Research, Rigshospitalet , Glostrup , Denmark.
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  • Stylianos Georgiadis, c Center for Rheumatology and Spine Diseases , Copenhagen Center for Arthritis Research, Rigshospitalet , Glostrup , Denmark.
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  • Kim Hørslev-Petersen, Danish Hospital for Rheumatic Diseases
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  • Bo Ejbjerg, Slagelse Hospital Region Zealand, Slagelse
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  • Merete Lund Hetland, c Center for Rheumatology and Spine Diseases , Copenhagen Center for Arthritis Research, Rigshospitalet , Glostrup , Denmark.
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  • Lykke Midtbøll Ørnbjerg, c Center for Rheumatology and Spine Diseases , Copenhagen Center for Arthritis Research, Rigshospitalet , Glostrup , Denmark.
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  • Daniel Glinatsi, c Center for Rheumatology and Spine Diseases , Copenhagen Center for Arthritis Research, Rigshospitalet , Glostrup , Denmark.
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  • Jakob Møller, From the Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital (A.D.K., S.E.B., B.G.N.), Faculty of Health and Medical Sciences (A.D.K., J.S.J., S.E.B., B.G.N.), The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital (A.D.K., S.E.B., B.G.N.), Department of Medicine and Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital (J.S.J.), and The Copenhagen City Heart Study, Frederiksberg Hospital, Copenhage
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  • Mikael Boesen, Bispebjerg and Frederiksberg University Hospital
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  • Kristian Stengaard-Pedersen
  • Ole Rintek Madsen, From the Department of Radiology, and the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, University of Copenhagen, Glostrup; Department of Clinical Medicine, Faculty of Health Sciences, and the Center for Rheumatology and Spine Diseases, Gentofte Hospital, and the Center for Rheumatology and Spine Diseases, Bispebjerg and Frederiksberg Hospital, and the Center for Rheumatology and Spine Diseases, Nordsjællands Hospital, and the Department of Radiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen; Department of Rheumatology, Sygehus Lillebaelt, Vejle; King Christian 10th Rheumatism Hospital, Graasten; Department of Radiology, and Department of Rheumatology, Aarhus University Hospital, Denmark., Eksperimentarium, Hellerup
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  • Bente Jensen, Bispebjerg and Frederiksberg University Hospital
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  • Jan Alexander Villadsen, Orthopedic Department, Regional Hospital Silkeborg, Silkeborg, Denmark.
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  • Ellen-Margrethe Hauge
  • Philip Bennett, From the Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital (A.D.K., S.E.B., B.G.N.), Faculty of Health and Medical Sciences (A.D.K., J.S.J., S.E.B., B.G.N.), The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital (A.D.K., S.E.B., B.G.N.), Department of Medicine and Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital (J.S.J.), and The Copenhagen City Heart Study, Frederiksberg Hospital, Copenhage
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  • Oliver Hendricks, Danish Hospital for Rheumatic Diseases
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  • Karsten Asmussen, Bispebjerg and Frederiksberg University Hospital
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  • Marcin Kowalski, Department of Pediatrics, Vendsyssel Hospital Hjørring, Hjørring, Denmark
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  • Hanne Lindegaard, j Department of Rheumatology , Odense University Hospital , Odense , Denmark.
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  • Henning Bliddal, Parker Institute
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  • Niels Steen Krogh, Zitelab Aps
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  • Torkell Ellingsen, g Department of Rheumatology , Odense University Hospital , Odense , Denmark.
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  • Agnete H Nielsen, Department of Rheumatology, Diagnostic Centre, Regional Hospital Silkeborg, Denmark.
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  • Lone Balding, Department of Radiology, Herlev-Gentofte University Hospital, Herlev,
  • Anne Grethe Jurik
  • Henrik S Thomsen, Department of Radiology, Herlev-Gentofte University Hospital, Herlev,
  • Mikkel Østergaard, c Center for Rheumatology and Spine Diseases , Copenhagen Center for Arthritis Research, Rigshospitalet , Glostrup , Denmark.

OBJECTIVES: To study if clinical, radiographic and MRI markers can predict MRI and radiographic damage progression and achievement of stringent remission in patients with established RA in clinical remission followed by a targeted treatment strategy.

METHODS: RA patients (DAS28-CRP <3.2, no swollen joints) receiving conventional synthetic DMARDs were randomized to conventional or MRI-targeted treat-to-target strategies with predefined algorithmic treatment escalations. Potentially predictive baseline variables were tested in multivariate logistic regression analyses.

RESULTS: In the 171 patients included, baseline MRI osteitis independently predicted progression in MRI erosion [odds ratio (OR) 1.13 (95% CI 1.06, 1.22)], joint space narrowing [OR 1.15 (95% CI 1.07, 1.24)] and combined damage [OR 1.23 (95% CI 1.13, 1.37)], while tenosynovitis independently predicted MRI erosion progression [OR 1.13 (95% CI 1.03, 1.25)]. A predictor of radiographic erosion progression was age, while gender predicted progression in joint space narrowing. Following an MRI treat-to-target strategy predicted stringent remission across all remission definitions: Clinical Disease Activity Index remission OR 2.94 (95% CI 1.25, 7.52), Simplified Disease Activity Index remission OR 2.50 (95% CI 1.01, 6.66), ACR/EULAR Boolean remission OR 5.47 (95% CI 2.33, 14.13). Similarly, low tender joint count and low patient visual analogue scale pain and global independently predicted achievement of more stringent remission.

CONCLUSION: Baseline MRI osteitis and tenosynovitis were independent predictors of 2 year MRI damage progression in RA patients in clinical remission, while independent predictors of radiographic damage progression were age and gender. Following an MRI treat-to-target strategy, low scores of patient-reported outcomes and low tender joint count predicted achievement of stringent remission.

TRIAL REGISTRATION: ClinicalTrials.gov (https://clinicaltrials.gov), NCT01656278.

OriginalsprogEngelsk
TidsskriftRheumatology (Oxford, England)
Vol/bind60
Nummer1
Sider (fra-til)380-391
Antal sider12
ISSN1462-0324
DOI
StatusUdgivet - 5 jan. 2021

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