RESEARCH - Using predicted disease outcome to provide differentiated treatment of early RA

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J Rheumatol. 2006 Jul 15; [Epub ahead of print] Related Articles,

Using Predicted Disease Outcome to Provide Differentiated Treatment of Early

Rheumatoid Arthritis.

de Vries-Bouwstra J, Le Cessie S, Allaart C, Breedveld F, Huizinga T.

OBJECTIVE: To determine the usefulness of a prediction model for making

treatment decisions in early rheumatoid arthritis (RA). METHODS: In 152

patients with early RA, progression of radiological damage during the first

year [sharp-van der Heijde (SH) score > 0] was assessed and used to define

actual disease outcome. Available variables at baseline were entered in a

multivariate regression analysis with progression score as dependent

variable. This model was used to predict disease outcome in every patient.

Using the standard deviations of the predicted disease outcome, patients

were divided into 3 groups: (1) severe disease: high probability (>/= 0.8)

for progression > 0, (2) mild disease: high probability (>/=0.8) for

progression </= 0, and (3) not classified: no high probability for either

option. It was determined how many patients could be classified by using

this model. RESULTS: One hundred nine patients (71.7%) showed joint damage

progression during the first year. Baseline variables available were: age,

sex, duration of symptoms, duration of morning stiffness, patient's global

assessment of disease activity, Health Assessment Questionnaire score,

swollen and painful joint count, bilateral compression pain in

metatarsophalangeals, rheumatoid factor positivity, erythrocyte

sedimentation rate, shared epitope positivity, SH-score, and the presence of

erosions. The R2 value (~ variation explained) of the prediction model was

0.36. By using this model 46.3% of patients could be classified as having

severe disease, 0% as having mild disease, and 53.7% could not be

classified.

CONCLUSION: To be able to make treatment decisions in early RA based on

predicted disease outcome, a better prediction of disease outcome is needed,

making the search for better prognostic variables urgent.

PMID: 16845710

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

6845710

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