RESEARCH - A prognostic model for functional outcome in early RA

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J Rheumatol. 2006 Jul 1; [Epub ahead of print]

A Prognostic Model for Functional Outcome in Early Rheumatoid Arthritis.

Bansback N, Young A, Brennan A, Dixey J.

OBJECTIVE: To construct a prognostic algorithm to predict 5-year functional

outcome in rheumatoid arthritis (RA), based on the Health Assessment

Questionnaire (HAQ). METHODS: Data from all patients with 5-year followup (n

= 985) were used from an inception cohort, the Early Rheumatoid Arthritis

Study (ERAS). Possibly relevant prognostic factors considered in the initial

stage of the model-building process were standard clinical, radiological,

and laboratory features measured at baseline and at 1 year. Multivariate

analysis was performed using logistic regression, and the predictive

performance of the model was tested using measures of discrimination and

calibration. RESULTS: Bootstrap resampling identified 6 variables that

consistently predicted severe functional outcome. Functional grade III/IV

(odds ratio 6.7) and HAQ at 1 year (odds ratio 2.4) were the most important.

Other variables included socioeconomic status, hemoglobin, and radiographic

and disease activity scores. Estimates of the regression coefficients and

performance were corrected for over-fitting. Reasonably large values for the

c-index (0.82) and the Nagelkerke R2 (0.39) indicate that the set of

prognostic factors explains the variation in outcome to a degree that

implies good prediction for individual patients.

CONCLUSION: The algorithm identifies patients in the first year of RA who

are likely to have poor function by 5 years and who could potentially

benefit from aggressive drug therapy. A nomogram is produced for simple

application of the model in clinical practice. While further external

validation is necessary, this model could allow clinicians to target

aggressive therapy earlier in a patient's disease course.

PMID: 16832851

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

6832851 & dopt=Abstract

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