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Disease activity measures at baseline predict structural damage progression: data from the randomized, controlled

Edward C Keystone1, Harris A Ahmad2, Yusuf Yazici3

  • 1Department of Rheumatology, University of Toronto, Toronto, ON, Canada.

Rheumatology (Oxford, England)
|December 11, 2019
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Summary

Routine Assessment of Patient Index Data 3, DAS28 (CRP), and modified DAS28 (CRP) effectively predict structural damage in rheumatoid arthritis (RA) patients. These indices offer valuable insights for managing RA progression and treatment strategies.

Keywords:
CDAIDAS28 (CRP)DMARDsM-DAS28 (CRP)RARAPID3SDAIclinical trialcomposite indicesdisease activity

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Area of Science:

  • Rheumatology
  • Clinical Trial Analysis
  • Disease Activity Measurement

Background:

  • Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by joint inflammation and potential for progressive structural damage.
  • Accurate prediction of structural damage is crucial for effective RA management and treatment decisions.
  • Existing disease activity indices aim to quantify disease severity but their predictive power for structural progression varies.

Purpose of the Study:

  • To evaluate the predictive ability of Routine Assessment of Patient Index Data 3 (RAPID3), Disease Activity Score 28 (DAS28) using C-reactive protein (CRP), and modified DAS28 (mDAS28) for structural damage progression in rheumatoid arthritis.
  • To compare the predictive performance of these indices against Simplified Disease Activity Index (SDADI) and Clinical Disease Activity Index (CDAI).

Main Methods:

  • A post hoc analysis of two Phase III randomized controlled trials (AMPLE and AVERT) involving patients with active RA.
  • Utilized logistic regression to assess the relationship between baseline disease activity scores and structural damage progression at various time points (6, 12, and 24 months).
  • Calculated receiver operating characteristic (ROC) curves to determine the predictive accuracy of the indices.

Main Results:

  • Baseline RAPID3, DAS28 (CRP), and mDAS28 (CRP) scores significantly predicted structural damage progression in both the AMPLE and AVERT trials (P < 0.05 and P < 0.01, respectively).
  • These indices demonstrated stronger predictive capabilities for structural damage compared to SDADI and CDAI.
  • The predictive accuracy was consistent across different patient populations and treatment durations.

Conclusions:

  • RAPID3, DAS28 (CRP), and mDAS28 (CRP) are robust predictors of structural damage progression in patients with rheumatoid arthritis.
  • These validated indices can aid clinicians in identifying patients at higher risk for structural damage, enabling timely therapeutic interventions.
  • The findings support the use of these disease activity measures for monitoring RA and guiding treatment strategies to prevent long-term joint damage.