RESEARCH - A matrix risk model for the prediction of rapid radiographic progression in patients with RA: BeSt

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Ann Rheum Dis 2010;69:1333-1337 doi:10.1136/ard.2009.121160

Clinical and epidemiological research

Concise report

A matrix risk model for the prediction of rapid radiographic

progression in patients with rheumatoid arthritis receiving different

dynamic treatment strategies: post hoc analyses from the BeSt study

K Visser1, Y P M Goekoop-Ruiterman2, J K de Vries-Bouwstra3, H K

Ronday2, P E H Seys4, P J S M Kerstens5, T W J Huizinga1, B A C

Dijkmans3, C F Allaart1

+ Author Affiliations

1Leiden University Medical Center, Leiden, The Netherlands

2HAGA Hospital, The Hague, The Netherlands

3VUMC, Amsterdam, The Netherlands

4Franciscus Hospital, Roosendaal, The Netherlands

5JBI, Amsterdam, The Netherlands

Abstract

Objectives To develop a matrix model for the prediction of rapid

radiographic progression (RRP) in subpopulations of patients with

recent-onset rheumatoid arthritis (RA) receiving different dynamic

treatment strategies.

Methods Data from 465 patients with recent-onset RA randomised to

receive initial monotherapy or combination therapy were used.

Predictors for RRP (increase in Sharp-van der Heijde score ≥5 after 1

year) were identified by multivariate logistic regression analysis.

For subpopulations, the estimated risk of RRP per treatment group and

the number needed to treat (NNT) were visualised in a matrix.

Results The presence of autoantibodies, baseline C-reactive protein

(CRP) level, erosion score and treatment group were significant

independent predictors of RRP in the matrix. Combination therapy was

associated with a markedly reduced risk of RRP. The positive and

negative predictive values of the matrix were 62% and 91%,

respectively. The NNT with initial combination therapy to prevent one

patient from RRP with monotherapy was in the range 2–3, 3–7 and 7–25

for patients with a high, intermediate and low predicted risk,

respectively.

Conclusion The matrix model visualises the risk of RRP for

subpopulations of patients with recent-onset RA if treated dynamically

with initial monotherapy or combination therapy. Rheumatologists might

use the matrix for weighing their initial treatment choice.

http://ard.bmj.com/content/69/7/1333.abstract

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