Performance of Matrix‐Based Risk Models for Rapid Radiographic Progression in a Cohort of Patients With Established Rheumatoid Arthritis. Issue 4 (28th March 2013)

• Record Type: Journal Article
• Authors: Lillegraven, Siri; Paynter, Nina; Prince, Femke H. M.; Shadick, Nancy A.; Haavardsholm, Espen A.; Frits, Michelle L.; Iannaccone, Christine K.; Kvien, Tore K.; Weinblatt, Michael E.; Solomon, Daniel H.
• Is Part Of: Arthritis care & research. Volume 65:Issue 4(2013:Apr.)
• Page Start: 526
• Page End: 533
• Publication Date: 2013-03-28
• Subjects: Arthritis -- Periodicals; Rheumatism -- Periodicals; 616.72
• DOI: 10.1002/acr.21870
• Languages: English
• ISSNs: 2151-464X

Abstract

<abstract abstract-type="main" xml:lang="en"> <title>Abstract</title> <sec id="abs1-1" sec-type="section"> <title>Objective</title> <p>Matrix‐based risk models have been proposed as a tool to predict rapid radiographic progression (RRP) in rheumatoid arthritis (RA), but the experience with such models is limited. We tested the performance of 3 risk models for RRP in an observational cohort.</p> </sec> <sec id="abs1-2" sec-type="section"> <title>Methods</title> <p>Subjects from an observational RA cohort with hand radiographs and necessary predictor variables to be classified by the risk models were identified (n = 478). RRP was defined as a yearly change in the Sharp/van der Heijde score of ≥5 units. Patients were placed in the appropriate matrix categories, with a corresponding predicted risk of RRP. The mean predicted probability for cases and noncases, integrated discrimination improvement, Hosmer‐Lemeshow statistics, and C statistics were calculated.</p> </sec> <sec id="abs1-3" sec-type="section"> <title>Results</title> <p>The median age was 59 years (interquartile range [IQR] 50–66 years), the median disease duration was 12 years (IQR 4–23 years), the median swollen joint count was 6 (IQR 2–13), 84% were women, and 86% had erosions at baseline. Twelve percent of patients (32 of 271) treated with synthetic disease‐modifying antirheumatic drugs (DMARDs) at baseline and 10% of patients (21 of 207) treated with biologic DMARDs experienced RRP. Most of the predictor variables had a skewed distribution in the population. All models had a suboptimal performance when applied to this cohort, with C statistics of 0.59 (model A), 0.65 (model B), and 0.57 (model C), and Hosmer‐Lemeshow chi‐square <italic>P</italic> values of 0.06 (model A), 0.005 (model B), and 0.05 (model C).</p> </sec> <sec id="abs1-4" sec-type="section"> <title>Conclusion</title> <p>Matrix risk models developed in clinical trials of patients with early RA had limited ability to predict RRP in this observational cohort of RA patients.</p> </sec> </abstract>