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Author(s):
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Merete Lund Hetland, Bo Ejbjerg, Mikkel
Østergaard, Søren Jacobsen, Aage Vestergaard, Anne Grethe Jurik, Kristian
Stengaard-Pedersen, Peter Junker, Tine Lottenburger, Ib Hansen, Lis
Smedegaard Andersen, Ulrik Tarp, Henrik Skjødt, Jens Kristian Pedersen, Ole Majgaard,
Anders J. Svendsen, Torkell Ellingsen, Gert Hansen, Hanne Lindegaard, Jørgen
Vallø, Trine Torfing, Henrik S. Thomsen, Kim Hørslev-Petersen. University Hospitals,
Copenhagen, South-Denmark and Århus, Denmark
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PURPOSE
To identify predictors of radiographic progression in a 2-year randomized,
clinical study (RCT) of patients with early (<6 months' duration), active
rheumatoid arthritis (RA).
METHODS
In 89 patients, participating in a double-blind, placebo-controlled RCT (the
CIMESTRA study (1)), baseline clinical/biochemical disease activity measures
(incl. DAS28), magnetic resonance imaging (MRI) of the non-dominant wrist and
metacarpophalangeal (MCP)-joints (scored according to the OMERACT RAMRIS),
conventional x-rays of hands, wrists and forefeet (Sharp/van der Heijde
method), serum anti-cyclic citrullinated peptide antibodies (anti-CCP), and
serum IgM RFwere available. Patients were treated aggressively with
methotrexate, intra-articular betamethasone and
cyclosporine/placebo-cyclosporine, aiming at clinical remission.
A multiple regression analysis with stepwise backward selection was performed
with delta Total Sharp/vdHeijde Score (TSS) from 0 to 2 years as the
dependent variable. Possible predictive baseline variables were tested:
DAS28, TSS, MRI bone oedema score, MRI synovitis score, MRI erosion score,
anti-CCP, IgM RF, age, gender, treatment arm, and cumulated betamethasone
dose from 0-3 months.
RESULTS
At baseline, the median DAS28 was 5.6 (range 2.4-8.0), 65% were IgM RF
positive, 61% were anti-CCP positive, and 56% had radiographic erosions. At 2
years, DAS28 was 2.0 (0.5-5.7), 56% were in DAS-remission, and 26% had
progressed radiographically.
The only independent predictor of delta TSS was the MRI bone oedema score
(p<0.00001), while the other variables did not reach statistical
significance (table). Bone oedema explained 41% of the variation in the
progression of radiographic score (Pearson's r=0.64).
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Multiple regression analysis before and after stepwise
backward selection
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All
explanatory variables in model
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Coefficient
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Confidence
interval
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P
value
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DAS28
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-0.60
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-1.48-0.28
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0.19
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TSS
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0.026
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-0.15-0.21
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0.78
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MRI
bone oedema score
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0.63
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0.37-0.89
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<0.00001
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MRI
synovitis score
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0.17
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-0.10-0.45
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0.22
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MRI
erosion score
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0.30
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-0.28-0.87
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0.32
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Anti-CCP
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1.93
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-1.12-4.99
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0.22
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IgM
RF
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-0.38
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-3.60-2.85
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0,82
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Age
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0.02
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-0.83-0.86
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0.69
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Gender
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-0.75
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-3.15-1.65
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0.54
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Treatment
arm
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-0.84
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-2.80-1.12
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0.40
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Cumulated
steroid
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<0.01
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-0.37-0.39
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0.96
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Only
significant variables in model
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MRI
bone odema score
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0.75
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0.56-0.97
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<0.00001
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CONCLUSIONS
In early RA patients treated aggressively in a RCT with DMARDs and
intraarticular corticosteroids aiming at remission, the OMERACT MRI bone
oedema score of MCP and wrist joints at baseline was a strong independent
predictor of radiographic progression in hands, wrists or feet during the
subsequent 2 years. MRI synovitis score, MRI erosion score, DAS28, anti-CCP
and IgM RF were not independent risk factors for radiographic progression.
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Disclosures:
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M.L. Hetland, None; B.
Ejbjerg, None; M. Østergaard, None; S. Jacobsen,
None; A. Vestergaard, None; A. Jurik, None; K.
Stengaard-Pedersen, None; P. Junker, None; T.
Lottenburger, None; I. Hansen, None; L.S. Andersen,
None; U. Tarp, None; H. Skjødt, None; J.K.
Pedersen, None; O. Majgaard, None; A.J. Svendsen,
None; T. Ellingsen, None; G. Hansen, None; H.
Lindegaard, None; J. Vallø, None; T. Torfing,
None; H.S. Thomsen, None; K. Hørslev-Petersen, None.
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