RESEARCH - Effectiveness of initial treatment allocation based on expert opinion for prevention of radiographic progression in early RA

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Ann Rheum Dis doi:10.1136/ard.2010.135319

Clinical and epidemiological research

Concise report

Effectiveness of initial treatment allocation based on expert opinion

for prevention of rapid radiographic progression in daily practice of

an early RA cohort

Anne Durnez1, Geert Vanderschueren2, Luc Lateur2, René Westhovens1,

Verschueren1

1Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium

2Departments of Radiology, University Hospitals Leuven, Leuven, Belgium

Correspondence to

Professor Verschueren, Department of Rheumatology, University

Hospital Leuven, Herestraat 49, B-3000 Leuven, Belgium;

patrick.verschueren@...

Accepted 1 November 2010

Published Online First 21 December 2010

Abstract

Objectives To evaluate expert treatment selection for early rheumatoid

arthritis and to validate a prediction model for rapid radiographic

progression (RRP) in daily practice.

Methods Patients received initial combination therapy with steroids

(ICTS) or disease-modifying antirheumatic drug monotherapy (IMT) after

informal evaluation of prognostic factors, followed by a tight control

strategy. Changes in Sharp/van der Heijde score (total Sharp score

(TSS)) of >5 units over 1 year (=RRP) were documented. The mean change

in TSS and proportion with RRP were compared between groups. Based on

the 28 swollen joint count, rheumatoid factor titre and C reactive

protein/erythrocyte sedimentation rate, patients were placed in the

ASPIRE prediction matrix, yielding a RRP risk. Numbers needed to treat

(NNT) intensively to avoid one RRP after 1 year were calculated.

Results The mean change in TSS after 1 year and the proportion with

RRP was lower in the ICTS group (n=37) than in the IMT group (n=43).

The mean calculated risk of RRP was higher in patients with

radiographic progression. The mean NNT intensively to prevent RRP was

lower in the ICTS group than in the IMT group. The positive predictive

value of NNT for RRP prevention was 12.6%, but the negative predictive

value reached 100%.

Conclusion ICTS seems more effective in preventing RRP than IMT. The

predictive matrix model could be helpful in preventing overtreatment

in practice.

http://ard.bmj.com/content/early/2011/01/12/ard.2010.135319.abstract?papetoc

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