An evaluation of molecular and clinical remission in rheumatoid arthritis by assessing radiographic progression

• Published in: Rheumatology (Oxford, England) Vol. 52; no. 5; pp. 839 - 846
• Main Authors: van der Helm-van Mil, Annette H M, Knevel, Rachel, Cavet, Guy, Huizinga, Tom W J, Haney, Douglas J
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-05-2013
• Subjects: Adult; Aged; Ambulatory Care; Ambulatory Care Facilities; Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - blood; Arthritis, Rheumatoid - diagnostic imaging; Arthritis, Rheumatoid - drug therapy; Arthritis, Rheumatoid - physiopathology; Biomarkers - blood; Biomarkers - metabolism; Clinical Science; Cohort Studies; Disease Progression; Female; Humans; Inflammation Mediators - blood; Male; Middle Aged; Monitoring, Physiologic - methods; Netherlands; Prognosis; Radiography; Risk Assessment; Sensitivity and Specificity; Severity of Illness Index; Treatment Outcome
• ISSN: 1462-0324; 1462-0332
• DOI: 10.1093/rheumatology/kes378

To determine whether molecular remission defined by a multi-biomarker disease activity (MBDA) score predicts a reduced risk of joint damage progression, and whether the MBDA score can augment existing classifications of remission.
The study examined 271 visits for 163 RA patients in the Leiden Early Arthritis Cohort. The MBDA score and other variables from each visit were evaluated for prediction of progression [change in Sharp-van der Heijde Score (ΔSHS) >3] over the ensuing 12 months. Positive likelihood ratios (PLRs) for non-progression were calculated for remission based upon DAS based on 28-joint counts and CRP (DAS28-CRP <2.32), EULAR/ACR Boolean criteria and MBDA score (≤25).
Ninety-three per cent of patients in MBDA-defined remission did not experience progression, compared with 70% of patients not in MBDA remission (P = 0.001). There were no significant differences in the fraction of non-progressers between patients in remission and those not in remission using either DAS28-CRP or EULAR/ACR criteria. The PLR for non-progression over 12 months for MBDA remission was 4.73 (95% CI 1.67, 15.0). Among patients in DAS28-CRP remission, those with a high MBDA score were 2.3 times as likely (95% CI 1.1, 3.7) to have joint damage progression during the next year.
MBDA-defined remission was an indicator of limited radiographic progression over the following 12 months. For patients in DAS28-CRP remission, high MBDA scores were a significant indicator of elevated risk of progression. MBDA results may provide a useful adjunct to clinical assessment to identify progression-free remission and assess subclinical disease.