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

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  • 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, University of Copenhagen
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  • Mikael Boesen, Bispebjerg and Frederiksberg University Hospital
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  • Kristian Stengaard-Pedersen
  • Ole Rintek Madsen, University of Copenhagen
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  • Bente Jensen, Bispebjerg and Frederiksberg University Hospital
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  • Jan Alexander Villadsen
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  • Ellen-Margrethe Hauge
  • Philip Bennett, University of Copenhagen
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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.

Original languageEnglish
JournalRheumatology
Volume60
Issue1
Pages (from-to)380-391
Number of pages12
ISSN1462-0324
DOIs
Publication statusPublished - Jan 2021

    Research areas

  • MRI, disease activity, joint damage progression, outcome research, predictors, remission, rheumatoid arthritis, treat-to-target

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