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A multibiomarker disease activity score for rheumatoid arthritis predicts radiographic joint damage in the BeSt study
Iris M Markusse1, Linda Dirven2, Marianne van den Broek2
1From the Department of Rheumatology, Leiden University Medical Center, Leiden; Reinier de Graaf Hospital, Delft; Maasstad Hospital, Rotterdam; Haga Hospital, the Hague; Reade organization; VU Medical Center, Amsterdam, the Netherlands; Crescendo Bioscience, South San Francisco, California, USA.I.M. Markusse, MD; L. Dirven, PhD; M. van den Broek, MD, PhD, Department of Rheumatology, Leiden University Medical Center; C. Bijkerk, MD, PhD, Department of Rheumatology, Reinier de Graaf Hospital; K.H. Han, MD, Department of Rheumatology, Maasstad Hospital; H.K. Ronday, MD, PhD, Department of Rheumatology, Haga Hospital; R. Bolce, MSN; E.H. Sasso, MD, Crescendo Bioscience; P.J.S.M. Kerstens, MD, PhD, Department of Rheumatology, Reade; W.F. Lems, MD, PhD, Department of Rheumatology, Reade, and VU Medical Center; T.W.J. Huizinga, MD, PhD; C.F. Allaart, MD, PhD, Department of Rheumatology, Leiden University Medical Center. i.m.markusse@lumc.nl.
Objective:
To determine whether a multibiomarker disease activity (MBDA) score predicts radiographic damage progression in the subsequent year in patients with early rheumatoid arthritis.
Methods:
There were 180 serum samples available in the BeSt study (trial numbers NTR262, NTR 265): 91 at baseline (84 with radiographs available) and 89 at 1-year followup (81 with radiographs available). Radiographs were assessed using the Sharp/van der Heijde Score (SvdH). Twelve serum biomarkers were measured to determine MBDA scores using a validated algorithm. Receiver-operating curves and Poisson regression analyses were performed, with Disease Activity Score (DAS) and MBDA score as independent variables, and radiographic progression as dependent variable.
Results:
At baseline, MBDA scores discriminated more between patients who developed radiographic progression (increase in SvdH≥5 points) and patients who did not [area under the curve (AUC) 0.767, 95% CI 0.639-0.896] than did DAS (AUC 0.521, 95% CI 0.358-0.684). At 1 year, MBDA score had an AUC of 0.691 (95% CI 0.453-0.929) and DAS had an AUC of 0.649 (95% CI 0.417-0.880). Adjusted for anticitrullinated protein antibody status and DAS, higher MBDA scores were associated with an increased risk for SvdH progression [relative risk (RR) 1.039, 95% CI 1.018-1.059 for baseline MBDA score; 1.037, 95% CI 1.009-1.065 for Year 1 MBDA score]. Categorized high MBDA scores were also correlated with SvdH progression (RR for high MBDA score at baseline 3.7; low or moderate MBDA score as reference). At 1 year, high MBDA score gave a RR of 4.6 compared to low MBDA score.
Conclusion:
MBDA scores predict radiographic damage progression at baseline and during disease course.
