Artretyzm – Rokowania, prognozy i postęp choroby

Artretyzm
Rokowania, prognozy i postęp choroby

Reumatoidalne zapalenie stawów (RZS) to przewlekła, ogólnoustrojowa choroba autoimmunologiczna charakteryzująca się symetrycznym, nadżerkowym zapaleniem wielostawowym. Przebieg choroby jest zróżnicowany, od subklinicznych form (ok. 10%) do agresywnych, wyniszczających postaci (10-15%). Kluczowe dla ograniczenia progresji i powikłań jest wczesne rozpoznanie i leczenie, z celem osiągnięcia i utrzymania remisji, co obejmuje całkowite stłumienie stanu zapalnego i bólu oraz zapobieganie niepełnosprawności. Czynniki prognostyczne złej odpowiedzi obejmują wysoką aktywność choroby (DAS28≥5,1), obecność wysokich mian autoprzeciwciał (RF, ACPA), początkowe uszkodzenia strukturalne widoczne w RTG, a także czynniki demograficzne jak płeć i wiek. Wczesne skierowanie do reumatologa (do 3 miesięcy od objawów) znacząco poprawia rokowanie. Modele predykcyjne, uwzględniające m.in. genotypy ABCB1 rs1045642 i ABCC3 rs4793665, palenie tytoniu, BMI≥25 kg/m² oraz parametry kliniczne (HAQ≥0,6), pozwalają na przewidywanie odpowiedzi na metotreksat z dokładnością do 80%.

Prognoza Artretyzmu – Ogólne informacje
Czynniki prognostyczne w RZS

Kluczowe czynniki prognostyczne
Przewidywanie uszkodzeń strukturalnych
Przewidywanie odpowiedzi na leczenie

Modele predykcyjne w RZS

Modele predykcyjne dla rozpoznania RZS
Modele predykcyjne odpowiedzi na leczenie
Modele predykcyjne powikłań RZS

Zastosowanie uczenia maszynowego w przewidywaniu prognozy RZS
Ograniczenia i wyzwania w przewidywaniu prognozy RZS
Praktyczne implikacje dla klinicystów
Przyszłe kierunki badań

Kolejne rozdziały

Prognoza Artretyzmu – Ogólne informacje

Artretyzm (reumatoidalne zapalenie stawów, RZS) jest przewlekłą, ogólnoustrojową chorobą autoimmunologiczną o nieznanej etiologii, której głównym objawem klinicznym jest nadżerkowe, symetryczne zapalenie wielostawowe¹. Przebieg choroby może być bardzo zróżnicowany – od łagodnych lub subklinicznych form (około 10%) do szybko postępujących i wyniszczających postaci (10-15%)². Obecnie nie ma leku całkowicie eliminującego RZS, jednak wczesna diagnostyka i skuteczne leczenie są kluczowe dla ograniczenia ciężkości choroby oraz zapobiegania powikłaniom³.

Ostatecznym celem farmakologicznego leczenia zapalnych chorób reumatycznych jest obecnie osiągnięcie i utrzymanie remisji, w tym całkowite stłumienie stanu zapalnego i bólu oraz zapobieganie niepełnosprawności i uszkodzeniom narządów. Jednakże trwała remisja, nie wspominając o całkowitym wyleczeniu, jest nadal trudna do osiągnięcia⁴. Osiągnięcie remisji lub stanu niskiej aktywności choroby stanowi ostateczny cel leczenia w chorobach reumatycznych⁵.

Czynniki prognostyczne w RZS

W reumatoidalnym zapaleniu stawów, prognoza może być definiowana na dwóch poziomach: wyniku choroby, w tym uszkodzenia stawów i ryzyka wystąpienia objawów pozastawowych i/lub powikłań, oraz wyniku leczenia, w tym odpowiedzi na terapię, ryzyka wystąpienia działań niepożądanych i remisji wolnej od leków⁶.

Kluczowe czynniki prognostyczne

Zidentyfikowano kilka czynników prognostycznych złej odpowiedzi (PPF), mianowicie wysoką aktywność choroby stawowej i ogólnoustrojowej (wynik złożony lub składnik wyniku), początkowe uszkodzenia strukturalne oraz obecność wysokich mian autoprzeciwciał (czynniki reumatoidalne, przeciwciała przeciw cyklicznemu cytrulinowanemu peptydowi – anty-CCP)⁷.

Czynnik reumatoidalny (RF) i przeciwciała przeciw cytrulinowanym peptydom (ACPA) – są użytecznymi testami u pacjentów z wczesnym zapaleniem stawów, ale ACPA mają większą wartość diagnostyczną i prognostyczną niż RF⁸
Zmiany strukturalne w badaniach RTG – uszkodzenia strukturalne widoczne w początkowych zdjęciach RTG rąk i stóp są predyktorem dalszej progresji radiograficznej u pacjentów z wczesnym zapaleniem stawów⁹
Wczesne skierowanie do reumatologa – pacjenci z wczesnym zapaleniem stawów skierowani do reumatologa w ciągu 3 miesięcy wykazują lepsze wyniki niż ci z późniejszym skierowaniem¹⁰
Wynik HAQ – w pierwszych trzech miesiącach przewidywał niepełnosprawność po 10 latach z ilorazem szans 13,4¹¹
Wiek i płeć – najsilniejszymi predyktorami remisji DAS28-ESR w ciągu 12-24 miesięcy, skorygowanymi o wiek i płeć, były: remisja na początku (iloraz szans [OR]: 4,49), płeć męska (OR: 2,42), abstynencja od alkoholu i niższa waga (OR: 0,98)¹²
Lokalizacja i rozmiar zajętych stawów – są przydatne do przewidywania rokowania pacjentów z reumatoidalnym zapaleniem stawów¹³

Przewidywanie uszkodzeń strukturalnych

U pacjentów z wczesnym zapaleniem stawów, obecność czynnika reumatoidalnego (RF) i/lub przeciwciał przeciw cytrulinowanym peptydom (ACPA), a także nadżerki radiograficzne, niezależnie przyczyniają się do przewidywania długoterminowej progresji radiograficznej¹⁴. W badaniach dotyczących niezróżnicowanego zapalenia stawów (UA), nadżerki na tradycyjnych radiogramach były silnymi predyktorami diagnozy RZS (dodatni wskaźnik wiarygodności (LR+) 3,5-10,9; iloraz szans 7,6 i 8,7)¹⁵.

Wybór uszkodzeń strukturalnych do określenia rokowania choroby jest jednak dyskusyjny, biorąc pod uwagę brak związku z funkcją i jakością życia¹⁶. W odniesieniu do rokowania zarówno w UA, jak i w populacjach mieszanych, znaleziono związek między liczbą nieprawidłowości na tradycyjnych radiogramach a złym rokowaniem¹⁷.

Przewidywanie odpowiedzi na leczenie

Identyfikacja czynników predykcyjnych odpowiedzi terapeutycznej jest bardzo istotna, jeśli chcemy zaoferować odpowiednie leczenie odpowiedniemu pacjentowi we właściwym czasie, unikając w ten sposób przedłużających się okresów aktywności choroby, które są źródłem progresji uszkodzeń strukturalnych, i zmniejszając ryzyko progresji do choroby trudnej w leczeniu¹⁸.

Wyniki badań R4RA i STRAP wykazują wartość stratyfikacji pacjentów według patotypów błony maziowej w przewidywaniu odpowiedzi na tocilizumab i rytuksymab¹⁹. Analiza regresji wieloczynnikowej liniowej i logistycznej zidentyfikowała biomarkery, które były predykcyjne dla remisji/braku remisji w terapii tocilizumabem i etanerceptem²⁰.

Modele predykcyjne w RZS

Kliniczne modele predykcyjne (CPM), znane również jako modele predykcji ryzyka lub skale ryzyka, są formułami matematycznymi używanymi do oszacowania prawdopodobieństwa, że dana osoba będzie miała chorobę lub dany wynik w przyszłości²¹.

Modele predykcyjne dla rozpoznania RZS

Zasada predykcyjna dla rozwoju reumatoidalnego zapalenia stawów u pacjentów z niezróżnicowanym zapaleniem stawów (UA) została zweryfikowana. Reguła ta dokładnie szacuje ryzyko RZS u ponad 75% pacjentów z niedawno rozpoczętym UA²². Pole pod krzywą (AUC) po zastosowaniu ponownie wyprowadzonej reguły predykcyjnej wynosiło 0,88, nieco niższe niż w oryginalnej regule. W trzech kohortach AUC wynosiło 0,83, 0,82 i 0,95; NPV (dla wyniku predykcji 6 lub niższego) wynosiło 83%, 83% i 86%; a PPV wynosiło 100%, 93% i 100%²³.

Kryteria RZS zastosowane do dokumentacji z pierwszej wizyty zidentyfikowały 24% pacjentów jako RZS (średni wynik EULAR 7,6), 30% jako niezróżnicowane zapalenie stawów (UA, średni wynik EULAR 3,6), podczas gdy pozostałe 45% pacjentów charakteryzowało się jako artralgia (średni wynik EULAR 2,3)²⁴.

Modele predykcyjne odpowiedzi na leczenie

Opracowano i zwalidowano model do przewidywania niewystarczającej odpowiedzi na metotreksat (MTX) po 3 miesiącach terapii, przed rozpoczęciem leczenia MTX w 2 dużych prospektywnych kohortach pacjentów z RZS. Model obejmował DAS28≥5,1 przed rozpoczęciem MTX, HAQ≥0,6, genotyp ABCB1 rs1045642, genotyp ABCC3 rs4793665, erytrocyty-folian≤750 nmol/L, aktualne palenie tytoniu i BMI≥25 kg/m². Model poprawnie klasyfikował 80% pacjentów w kohorcie wyprowadzenia i walidacji²⁵.

Modele predykcyjne powikłań RZS

Choroby układu sercowo-naczyniowego (CVD) są jednym z najczęstszych powikłań RZS i główną przyczyną śmiertelności pacjentów, stanowiąc 30-40% zgonów²⁶. Drugą główną przyczyną śmierci u pacjentów z RZS są choroby układu oddechowego, które występują u 30-40% pacjentów²⁷.

Rozszerzony model punktacji ryzyka dla CVD w RZS (ERS-RA) został opracowany w celu przewidywania 10-letniej prawdopodobieństwa zdarzenia CV, takiego jak zawał mięśnia sercowego, udar mózgu lub śmierć związana z CV²⁸.

W przypadku śródmiąższowej choroby płuc związanej z RZS (RA-ILD), badanie ujawniło, że wiek wyjściowy i zmiany w poziomach surowicy MMP-13 oraz CXCL11 były związane z ryzykiem progresji RA-ILD²⁹. Po 5 latach 32% pacjentów wykazało postępującą RA-ILD, 35% było stabilnych, a 33% poprawiło się³⁰.

Zastosowanie uczenia maszynowego w przewidywaniu prognozy RZS

Wyniki badań sugerują, że uczenie maszynowe (ML) może zapewnić dokładną prognozę nawrotu u pacjentów z RZS, a wykorzystanie algorytmów predykcyjnych może ułatwić spersonalizowane opcje leczenia³¹. Połączenie badania ultrasonograficznego i danych z badań krwi wykazało wyższe AUC niż te obliczone przy użyciu pojedynczych danych³².

Wśród dziesięciu cech wybranych przez RFE (Recursive Feature Elimination) w XGBoost, wyniki SMI nadgarstka i MTP były dwoma najważniejszymi cechami, co sugeruje, że dane ultrasonograficzne znacznie poprawiły przewidywanie nawrotu u pacjentów z RZS³³.

Badanie przeprowadzone na danych z regionalnego szpitala na Tajwanie wykazało, że techniki oparte na drzewach decyzyjnych mogą być bardziej wydajne i dokładne niż inne tradycyjne klasyfikatory oparte na funkcjach, a te podejścia oparte na drzewach decyzyjnych mogłyby być szeroko przyjęte w celu pomocy lekarzom w podejmowaniu lepszych decyzji dotyczących leków³⁴. Wyniki pokazują, że dokładność modelu predykcyjnego według modułów Logistic, SVM i DT wynosiła odpowiednio 0,7927, 0,7829 i 0,9094³⁵.

Ograniczenia i wyzwania w przewidywaniu prognozy RZS

Pomimo znacznych postępów w opracowaniu modeli predykcyjnych dla RZS, pozostają pewne wyzwania i ograniczenia. Niepewność utrzymuje się co do optymalnego modelu (modeli) predykcyjnego do zastosowania w praktyce klinicznej³⁶. Ogólnie rzecz biorąc, istnieje niewystarczająca ilość dowodów na to, że efekt leczenia zależy od charakterystyki wyjściowej³⁷.

Bardziej ogólnie, nie wydaje się istnieć związek między obecnością czynników prognostycznych złej odpowiedzi (PPF) a wynikiem choroby lub odpowiedzią na leczenie, jak pokazano w badaniach terapeutycznych BeSt i IMPROVED, gdzie punktem końcowym była progresja uszkodzeń, którym zapobiegały otrzymane leczenia³⁸. Ważne jest, aby zauważyć, że PPF stosowane w międzynarodowych zaleceniach mogą być różne, ponieważ te zdefiniowane przez American College of Rheumatology 2008 obejmowały choroby pozastawowe³⁹.

Praktyczne implikacje dla klinicystów

Wczesne rozpoznanie i leczenie RZS ma kluczowe znaczenie. Pacjenci z RZS, u których istnieje ryzyko nieosiągnięcia remisji, obejmują osoby z wysoką aktywnością choroby na początku, kobiety, osoby pijące alkohol i osoby o wyższej masie ciała⁴⁰.

Wyniki badań wyraźnie potwierdzają potrzebę wczesnego skierowania (najlepiej w ciągu 3 miesięcy od wystąpienia objawów) pacjentów z wczesnym zapaleniem stawów do reumatologa, w celu zmniejszenia prawdopodobieństwa uszkodzenia stawów i poprawy wyników klinicznych⁴¹.

W celu optymalizacji terapeutycznego zarządzania wczesnym RZS konieczne jest przeprowadzanie okresowych ocen odpowiedzi klinicznej i badań laboratoryjnych na zastosowane leczenie, a także parametrów wskazujących na rokowanie choroby⁴².

Gdy pacjent jest w trwałej remisji, wskazane jest próba zmniejszenia dawki lub nawet zaprzestanie stosowania aktualnego DMARD⁴³. Celem jest szybkie rozpoczęcie dodatkowych terapii biologicznych lub inhibitorów szlaku JAK dla tych osób, aby zminimalizować aktywność choroby i spowolnić jej progresję⁴⁴.

Przyszłe kierunki badań

Identyfikacja wiarygodnych biomarkerów predykcyjnych ułatwi przestrzeganie zaleceń EULAR dotyczących leczenia do celu, umożliwiając klinicystom wcześniejsze poznanie, czy strategia leczenia osiągnie cel leczenia, który został wcześniej określony dla każdego pacjenta z RZS⁴⁵.

Odkrycie biomarkerów w surowicy przed leczeniem, które mogą przewidzieć wynik kliniczny chorych na RZS, może pomóc lekarzom w identyfikacji z wyprzedzeniem pacjentów, którzy nie będą korzystnie reagować na protokół leczenia, oszczędzając pacjentom leczenia kosztownymi i silnymi środkami, które nie są dla nich skuteczne⁴⁶.

Przyszłe badania powinny skupić się na walidacji istniejących modeli predykcyjnych w różnych populacjach oraz na opracowaniu nowych modeli uwzględniających najnowsze biomarkery i technologie obrazowania. Trwające badania nad zastosowaniem uczenia maszynowego i sztucznej inteligencji w analizie danych medycznych mogą również przyczynić się do opracowania bardziej precyzyjnych i spersonalizowanych strategii prognozowania i leczenia RZS.

Kolejne rozdziały

Zapraszamy do dalszego czytania naszego leksykonu.

Wybierz kolejny rozdział z menu poniżej, aby otworzyć nową podstronę kompedium wiedzy i uzyskać szczegółowe informację o leku, substancji lub chorobie.

Materiały źródłowe

#1 Clinical prediction models of rheumatoid arthritis and its complications: focus on cardiovascular disease and interstitial lung disease | Arthritis Research & Therapy | Full Text
https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-023-03140-5
Rheumatoid arthritis (RA) is a chronic, systemic, autoimmune disease of unknown etiology with erosive, symmetric polyarthritis as the main clinical manifestations. […] Clinical prediction models (CPMs), also known as risk prediction models or risk scores, are mathematical formulas used to estimate the probability that a given individual will have a disease or an outcome in the future. […] Currently, there is no cure for RA, but effective early diagnosis and treatment are crucial for limiting the severity of the disease and preventing the occurrence and development of complications. […] Therefore, in addition to new drug development and mechanism research, it is equally important to predict the effective response of RA patients to therapeutic drugs and early identification of patients who are prone to various complications.
#2 (PDF) Assessing prognosis and prediction of treatment response in early rheumatoid arthritis: systematic reviews
https://www.academia.edu/52425671/Assessing_prognosis_and_prediction_of_treatment_response_in_early_rheumatoid_arthritis_systematic_reviews
The progression of rheumatoid arthritis (RA) is quite variable, ranging from very mild or subclinical forms (approx. 10%) to rapidly progressing and debilitating forms (10-15%). […] To optimise the therapeutic management of early RA it is necessary to perform periodic evaluations of the clinical and laboratory test responses to the treatment instituted, as well as the parameters indicating disease prognosis. […] The HAQ score during the first three months predicted disability at 10 years with an odds ratio of 13.4. […] Prospective studies such as this give important knowledge of the variable long term prognosis of RA and provide necessary background information for clinical trials of new treatment modalities. […] The use of quantitative measures to analyse the long-term course of RA appears to have provided new insights into the severe morbidity and increased mortality rates of this disease.
#3 Clinical prediction models of rheumatoid arthritis and its complications: focus on cardiovascular disease and interstitial lung disease | Arthritis Research & Therapy | Full Text
https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-023-03140-5
Rheumatoid arthritis (RA) is a chronic, systemic, autoimmune disease of unknown etiology with erosive, symmetric polyarthritis as the main clinical manifestations. […] Clinical prediction models (CPMs), also known as risk prediction models or risk scores, are mathematical formulas used to estimate the probability that a given individual will have a disease or an outcome in the future. […] Currently, there is no cure for RA, but effective early diagnosis and treatment are crucial for limiting the severity of the disease and preventing the occurrence and development of complications. […] Therefore, in addition to new drug development and mechanism research, it is equally important to predict the effective response of RA patients to therapeutic drugs and early identification of patients who are prone to various complications.
#4 Outcome measures in inflammatory rheumatic diseases | Arthritis Research & Therapy | Full Text
https://arthritis-research.biomedcentral.com/articles/10.1186/ar2745
Inflammatory rheumatic diseases are generally multifaceted disorders and, therefore, measurement of multiple outcomes is relevant to most of these diseases. […] The ultimate goal of pharmacological treatment in the inflammatory rheumatic diseases nowadays is to reach and sustain remission, including the complete suppression of inflammation and pain and the prevention of excess disability and organ damage. However, sustained remission, not to mention cure, is still difficult to reach. […] Mortality in RA was explored initially in 1953 and since then numerous other studies have investigated mortality among patients with RA, with most demonstrating reduced life expectancy ranging from 5 to 15 years compared with the general population. […] Observing improving trends of survival over calendar time in rheumatic disorders is an important outcome of the quality of rheumatology care for these patients. […] Reaching remission, or a state of low disease activity, is the ultimate goal of treatment in rheumatic disorders. […] Following treatment success in RA, the vision of pharmacological treatment in the inflammatory rheumatic diseases nowadays has become reaching and sustaining remission.
#5 Outcome measures in inflammatory rheumatic diseases | Arthritis Research & Therapy | Full Text
https://arthritis-research.biomedcentral.com/articles/10.1186/ar2745
Inflammatory rheumatic diseases are generally multifaceted disorders and, therefore, measurement of multiple outcomes is relevant to most of these diseases. […] The ultimate goal of pharmacological treatment in the inflammatory rheumatic diseases nowadays is to reach and sustain remission, including the complete suppression of inflammation and pain and the prevention of excess disability and organ damage. However, sustained remission, not to mention cure, is still difficult to reach. […] Mortality in RA was explored initially in 1953 and since then numerous other studies have investigated mortality among patients with RA, with most demonstrating reduced life expectancy ranging from 5 to 15 years compared with the general population. […] Observing improving trends of survival over calendar time in rheumatic disorders is an important outcome of the quality of rheumatology care for these patients. […] Reaching remission, or a state of low disease activity, is the ultimate goal of treatment in rheumatic disorders. […] Following treatment success in RA, the vision of pharmacological treatment in the inflammatory rheumatic diseases nowadays has become reaching and sustaining remission.
#6 On difficulties to define prognostic factors for clinical practice in rheumatoid arthritis | RMD Open
https://rmdopen.bmj.com/content/10/3/e004472
In rheumatoid arthritis (RA), the identification of prognostic factors (PF) capable of predicting disease outcome, response to treatment or success of dose reduction is an important issue, as these factors are intended to serve as a basis for decision-making. […] In RA, prognosis can be defined at two levels: disease outcome, including joint damage and risk of extra-articular manifestations and/or complications, and treatment outcome, including response to therapy, risk of adverse effects and drug-free remission. […] Disease outcome has been assessed in different ways, using different definitions reflecting disease activity, structural damage, function, quality of life, pain, occurrence of extra-articular manifestations, etc. […] Using definition of RRP, several poor prognostic factors (PPF) have been identified, namely high articular and systemic disease activity (composite score or score component), initial structural damage and the presence of high titers of autoantibodies (rheumatoid factors, anticyclic citrullinated peptide (CCP)).
#7 On difficulties to define prognostic factors for clinical practice in rheumatoid arthritis | RMD Open
https://rmdopen.bmj.com/content/10/3/e004472
In rheumatoid arthritis (RA), the identification of prognostic factors (PF) capable of predicting disease outcome, response to treatment or success of dose reduction is an important issue, as these factors are intended to serve as a basis for decision-making. […] In RA, prognosis can be defined at two levels: disease outcome, including joint damage and risk of extra-articular manifestations and/or complications, and treatment outcome, including response to therapy, risk of adverse effects and drug-free remission. […] Disease outcome has been assessed in different ways, using different definitions reflecting disease activity, structural damage, function, quality of life, pain, occurrence of extra-articular manifestations, etc. […] Using definition of RRP, several poor prognostic factors (PPF) have been identified, namely high articular and systemic disease activity (composite score or score component), initial structural damage and the presence of high titers of autoantibodies (rheumatoid factors, anticyclic citrullinated peptide (CCP)).
#8 Diagnosis, prognosis and classification of early arthritis: results of a systematic review informing the 2016 update of the EULAR recommendations for the management of early arthritis
https://pmc.ncbi.nlm.nih.gov/articles/PMC5237764/
Patients with EA referred to a rheumatologist within 3 months show better outcomes than those with later referral. […] Structural damage on baseline X-rays of hands and feet is predictive of further radiographic progression in patients with EA. […] This systematic literature review (SLR) highlights the importance of early referral of patients with EA to the rheumatologist and confirms that the RF and mainly ACPAs serological status, as well as the radiographic status, are of value in the diagnosis and prognosis of patients with EA. […] RF and ACPAs are useful tests in patients with EA but ACPAs have more diagnostic and prognostic value than RF. […] Our results, as well as evidence from previously published literature, clearly supports the need for early referral (ideally within 3 months of symptom onset) of patients with EA to a rheumatologist, in order to reduce the likelihood of joint damage and to improve clinical outcomes. […] Prognostic values of RF and ACPAs in terms of predicting radiographic progression were very dependent on the prevalence of radiographic progression in the studies but NPVs were in general higher for ACPAs (around 80%) than for RF.
#9 Diagnosis, prognosis and classification of early arthritis: results of a systematic review informing the 2016 update of the EULAR recommendations for the management of early arthritis
https://pmc.ncbi.nlm.nih.gov/articles/PMC5237764/
Patients with EA referred to a rheumatologist within 3 months show better outcomes than those with later referral. […] Structural damage on baseline X-rays of hands and feet is predictive of further radiographic progression in patients with EA. […] This systematic literature review (SLR) highlights the importance of early referral of patients with EA to the rheumatologist and confirms that the RF and mainly ACPAs serological status, as well as the radiographic status, are of value in the diagnosis and prognosis of patients with EA. […] RF and ACPAs are useful tests in patients with EA but ACPAs have more diagnostic and prognostic value than RF. […] Our results, as well as evidence from previously published literature, clearly supports the need for early referral (ideally within 3 months of symptom onset) of patients with EA to a rheumatologist, in order to reduce the likelihood of joint damage and to improve clinical outcomes. […] Prognostic values of RF and ACPAs in terms of predicting radiographic progression were very dependent on the prevalence of radiographic progression in the studies but NPVs were in general higher for ACPAs (around 80%) than for RF.
#10 Diagnosis, prognosis and classification of early arthritis: results of a systematic review informing the 2016 update of the EULAR recommendations for the management of early arthritis
https://pmc.ncbi.nlm.nih.gov/articles/PMC5237764/
Patients with EA referred to a rheumatologist within 3 months show better outcomes than those with later referral. […] Structural damage on baseline X-rays of hands and feet is predictive of further radiographic progression in patients with EA. […] This systematic literature review (SLR) highlights the importance of early referral of patients with EA to the rheumatologist and confirms that the RF and mainly ACPAs serological status, as well as the radiographic status, are of value in the diagnosis and prognosis of patients with EA. […] RF and ACPAs are useful tests in patients with EA but ACPAs have more diagnostic and prognostic value than RF. […] Our results, as well as evidence from previously published literature, clearly supports the need for early referral (ideally within 3 months of symptom onset) of patients with EA to a rheumatologist, in order to reduce the likelihood of joint damage and to improve clinical outcomes. […] Prognostic values of RF and ACPAs in terms of predicting radiographic progression were very dependent on the prevalence of radiographic progression in the studies but NPVs were in general higher for ACPAs (around 80%) than for RF.
#11 (PDF) Assessing prognosis and prediction of treatment response in early rheumatoid arthritis: systematic reviews
https://www.academia.edu/52425671/Assessing_prognosis_and_prediction_of_treatment_response_in_early_rheumatoid_arthritis_systematic_reviews
The progression of rheumatoid arthritis (RA) is quite variable, ranging from very mild or subclinical forms (approx. 10%) to rapidly progressing and debilitating forms (10-15%). […] To optimise the therapeutic management of early RA it is necessary to perform periodic evaluations of the clinical and laboratory test responses to the treatment instituted, as well as the parameters indicating disease prognosis. […] The HAQ score during the first three months predicted disability at 10 years with an odds ratio of 13.4. […] Prospective studies such as this give important knowledge of the variable long term prognosis of RA and provide necessary background information for clinical trials of new treatment modalities. […] The use of quantitative measures to analyse the long-term course of RA appears to have provided new insights into the severe morbidity and increased mortality rates of this disease.
#12 (PDF) Assessing prognosis and prediction of treatment response in early rheumatoid arthritis: systematic reviews
https://www.academia.edu/52425671/Assessing_prognosis_and_prediction_of_treatment_response_in_early_rheumatoid_arthritis_systematic_reviews
Rheumatoid arthritis (RA) is a chronic, debilitating disease associated with reduced quality of life and substantial costs. It is unclear which tests and assessment tools allow the best assessment of prognosis in people with early RA and whether or not variables predict the response of patients to different drug treatments. […] The strongest age and sex adjusted baseline predictors of DAS28-ESR remission at 12-24 months were remission at baseline (odds ratio [OR]: 4.49, 95% CI: 2.17-9.29, P 0.001), being male (OR: 2.42, 95% CI: 1.46-4.01, P 0.001), abstaining from alcohol (P 0.001) and being lower weight (OR: 0.98, 95% CI: 0.97-1.00, P = 0.015). […] In this observational study, patients with early RA at risk of not achieving remission include those with high disease activity at baseline, women, those who drink alcohol and those with higher body weight.
#13 Location and Size of Affected Joints Are Useful to Predict Prognosis of Patients with Rheumatoid Arthritis – ACR Meeting Abstracts
https://acrabstracts.org/abstract/location-and-size-of-affected-joints-are-useful-to-predict-prognosis-of-patients-with-rheumatoid-arthritis/
Location and Size of Affected Joints Are Useful to Predict Prognosis of Patients with Rheumatoid Arthritis […] To predict prognosis of patients with rheumatoid arthritis (RA) from the location and the size of affected joints. […] Classification of RA patients according to the joint index vector which has the affected joints information of the location and the size discriminated patients with a relatively poor prognosis from those with lower SDAI and better HAQ-DI.
#14 Diagnosis, prognosis and classification of early arthritis: results of a systematic review informing the 2016 update of the EULAR recommendations for the management of early arthritis
https://pmc.ncbi.nlm.nih.gov/articles/PMC5237764/
To update the evidence pertaining to the diagnosis, prognosis and classification of patients with early arthritis (EA), and to inform the 2016 European League Against Rheumatism (EULAR) recommendations for the management of patients with EA. […] We confirmed that structural damage on baseline X-rays is predictive of further radiographic progression in patients with EA. […] This SLR highlights the importance of early referral for patients with EA and confirms that RF and mainly ACPAs as well as a search for structural X-rays changes may help in the diagnosis and prognosis of patients with EA. […] Patients with early arthritis (EA), the presence of rheumatoid factor (RF) and/or anticitrullinated-peptide antibodies (ACPAs) as well as radiographic erosions, independently contribute to predicting long-term radiographic progression.
#15 The Value of Conventional Radiographs in Undifferentiated Arthritis: A Systematic Review | The Journal of Rheumatology
https://www.jrheum.org/content/87/26
Objective. To perform a systematic literature review on the diagnostic and predictive value of conventional radiographs (CR) in patients with undifferentiated arthritis (UA). […] In studies on UA, erosions on CR were strong predictors of RA diagnosis [positive likelihood ratio (LR+) 3.510.9; odds ratio 7.6 and 8.7). […] With regard to prognosis in both UA and mixed populations, an association was found between number of abnormalities on CR and poor outcome. […] Several studies, in pure UA and mixed populations, clearly demonstrate that CR are helpful in predicting future diagnosis of RA or worse prognosis. However, absence of abnormalities on CR does not sufficiently exclude RA or other unfavorable outcome. […] Abnormalities on radiographs might also be valuable in predicting other outcomes in UA, such as structural damage or impaired physical functioning. […] In conclusion, radiographs can be a valuable test in patients with UA and in mixed populations for predicting diagnosis and prognosis.
#16 On difficulties to define prognostic factors for clinical practice in rheumatoid arthritis | RMD Open
https://rmdopen.bmj.com/content/10/3/e004472
More generally, there does not appear to be any relationship between the presence of PPF and the outcome of the disease or response to treatment, as illustrated in the BeSt and IMPROVED therapeutic trials where the endpoint was damage progression which was prevented by the treatments received. […] It is important to note that the PPF used in the international recommendations may be different, since those defined by the American College of Rheumatology 2008 included extra-articular diseases. […] The choice of structural damage to define the prognosis of the disease is open to question, given the lack of relationship with function and quality of life. […] In this respect, the T2T concept has also been extended to other diseases, such as spondyloarthritis, psoriatic arthritis and, more recently, systemic lupus erythematosus.
#17 The Value of Conventional Radiographs in Undifferentiated Arthritis: A Systematic Review | The Journal of Rheumatology
https://www.jrheum.org/content/87/26
Objective. To perform a systematic literature review on the diagnostic and predictive value of conventional radiographs (CR) in patients with undifferentiated arthritis (UA). […] In studies on UA, erosions on CR were strong predictors of RA diagnosis [positive likelihood ratio (LR+) 3.510.9; odds ratio 7.6 and 8.7). […] With regard to prognosis in both UA and mixed populations, an association was found between number of abnormalities on CR and poor outcome. […] Several studies, in pure UA and mixed populations, clearly demonstrate that CR are helpful in predicting future diagnosis of RA or worse prognosis. However, absence of abnormalities on CR does not sufficiently exclude RA or other unfavorable outcome. […] Abnormalities on radiographs might also be valuable in predicting other outcomes in UA, such as structural damage or impaired physical functioning. […] In conclusion, radiographs can be a valuable test in patients with UA and in mixed populations for predicting diagnosis and prognosis.
#18 On difficulties to define prognostic factors for clinical practice in rheumatoid arthritis | RMD Open
https://rmdopen.bmj.com/content/10/3/e004472
However, the identification of predictive factors of therapeutic response is of great interest if we want to offer the right treatment to the right patient at the right time, thus avoiding prolonged periods of disease activity, which are a source of progression of structural damage, and reducing the risk of progression to a disease that is difficult to treat. […] The results of the R4RA and STRAP studies demonstrate the value of stratifying patients according to synovial pathotypes to predict response to tocilizumab and rituximab. […] When the patient is in persistent remission, it is advisable to try to taper or even to discontinue the current DMARD. […] As a result, a large number of PPF have been identified, but their relevance remains questionable due to limited replication, with the exception of a few (disease duration, time to achieve remission on bDMARD (bDMARD, biologic disease-modifying antirheumatic drugs), etc).
#19 On difficulties to define prognostic factors for clinical practice in rheumatoid arthritis | RMD Open
https://rmdopen.bmj.com/content/10/3/e004472
However, the identification of predictive factors of therapeutic response is of great interest if we want to offer the right treatment to the right patient at the right time, thus avoiding prolonged periods of disease activity, which are a source of progression of structural damage, and reducing the risk of progression to a disease that is difficult to treat. […] The results of the R4RA and STRAP studies demonstrate the value of stratifying patients according to synovial pathotypes to predict response to tocilizumab and rituximab. […] When the patient is in persistent remission, it is advisable to try to taper or even to discontinue the current DMARD. […] As a result, a large number of PPF have been identified, but their relevance remains questionable due to limited replication, with the exception of a few (disease duration, time to achieve remission on bDMARD (bDMARD, biologic disease-modifying antirheumatic drugs), etc).
#20 Pretreatment Prediction of Individual Rheumatoid Arthritis Patientsâ Response to Anti-Cytokine Therapy Using Serum Cytokine/Chemokine/Soluble Receptor Biomarkers | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0132055
Multiple linear regression and multiple logistic regression analyses identified biomarkers that were predictive of remission/non-remission in tocilizumab and etanercept therapy. […] We discovered biomarkers in RA pretreatment serum that predicted their week 16 DAS28-CRP score and clinical outcome to tocilizumab therapy. […] We believe that identifying reliable predictive biomarkers will make it easier to follow EULARs treat-to-target recommendation by allowing clinicians to know in advance if a treatment strategy will achieve the treatment goal (target) that has been pre-determined for each RA patient. […] We believe that making a prediction before therapy using blood serum may be possible because patients serum cytokine/chemokine levels tend to reflect patients disease and genetic status.
#21 Clinical prediction models of rheumatoid arthritis and its complications: focus on cardiovascular disease and interstitial lung disease | Arthritis Research & Therapy | Full Text
https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-023-03140-5
Rheumatoid arthritis (RA) is a chronic, systemic, autoimmune disease of unknown etiology with erosive, symmetric polyarthritis as the main clinical manifestations. […] Clinical prediction models (CPMs), also known as risk prediction models or risk scores, are mathematical formulas used to estimate the probability that a given individual will have a disease or an outcome in the future. […] Currently, there is no cure for RA, but effective early diagnosis and treatment are crucial for limiting the severity of the disease and preventing the occurrence and development of complications. […] Therefore, in addition to new drug development and mechanism research, it is equally important to predict the effective response of RA patients to therapeutic drugs and early identification of patients who are prone to various complications.
#22 Disease outcome prediction rule for arthritis validated
https://www.hcplive.com/view/disease-outcome-prediction-rule-arthritis-validated
A prediction rule for the development of rheumatoid arthritis (RA) in patients with undifferentiated arthritis (UA) has been validated. The rule accurately estimates the risk of RA in more than 75% of patients with recent-onset UA. […] The AUC after application of the rederived prediction rule was 0.88, slightly lower than that from the original rule. In the 3 cohorts, the AUC was 0.83, 0.82, and 0.95; the NPV (for a prediction score of 6 or lower) was 83%, 83%, and 86%; and the PPV was 100%, 93%, and 100%. […] The authors noted that the rule may be useful in daily practice for reducing undertreatment and overtreatment of patients with UA.
#23 Disease outcome prediction rule for arthritis validated
https://www.hcplive.com/view/disease-outcome-prediction-rule-arthritis-validated
A prediction rule for the development of rheumatoid arthritis (RA) in patients with undifferentiated arthritis (UA) has been validated. The rule accurately estimates the risk of RA in more than 75% of patients with recent-onset UA. […] The AUC after application of the rederived prediction rule was 0.88, slightly lower than that from the original rule. In the 3 cohorts, the AUC was 0.83, 0.82, and 0.95; the NPV (for a prediction score of 6 or lower) was 83%, 83%, and 86%; and the PPV was 100%, 93%, and 100%. […] The authors noted that the rule may be useful in daily practice for reducing undertreatment and overtreatment of patients with UA.
#24 SAT0075âValidation of The Rheumatoid Arthritis Prediction Rules for The Disease Development in Patients with Joint Pain from West Sweden | Annals of the Rheumatic Diseases
https://ard.bmj.com/content/75/Suppl_2/692.1
Rheumatoid arthritis (RA) is a joint destructive disease, which leads to physical disability. There is no cure of RA today. Thus, recognition of RA at preclinical stages is essential for successful treatment. […] To validate and improve known prediction rules aiming at early recognition of clinically suspect arthralgia and diagnosis of RA. […] The RA criteria applied to the records of the first visit identified 24% of patients as RA (EULAR score mean 7.6), 30% as undifferentiated arthritis (UA, EULAR score mean 3.6), while the remaining 45% of the patients were characterized as arthralgia (EULAR score mean 2.3). […] Both prediction rules are shown to be sensitive identify RA patients at assessment. The clinical 16-point assessment has prospective sensitivity for new cases. This is shown independently of autoantibody status and family history of RA.
#25 Development and validation of a prognostic multivariable model to predict insufficient clinical response to methotrexate in rheumatoid arthritis | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0208534
The objective was to predict insufficient response to 3 months methotrexate (MTX) in DMARD nave rheumatoid arthritis patients. […] A prognostics prediction model for insufficient response to MTX in 2 prospective RA cohorts by combining genetic, metabolic, clinical and lifestyle variables was developed and validated. This model satisfactorily identified RA patients with high risk of insufficient response to MTX. […] Prediction of MTX non-response before MTX start is paramount since first months upon diagnosis represent a window of opportunity during which outcomes can be more effectively modulated by therapy. […] We developed and validated a model, which could predict insufficient response to MTX after 3 months of therapy, before start of MTX treatment in 2 large prospective cohorts including patients with RA. The model included DAS285.1 before start of MTX, HAQ0.6, ABCB1 rs1045642 genotype, ABCC3 rs4793665 genotype, erythrocyte-folate750 nmol/L, current smoking and BMI25 kg/m2. The model classified 80% of patients correctly in the derivation and validation cohort. […] This prediction model should be validated in a trial where insufficient response is predicted before treatment is started and patients treated according to the predicted insufficient response.
#26 Clinical prediction models of rheumatoid arthritis and its complications: focus on cardiovascular disease and interstitial lung disease | Arthritis Research & Therapy | Full Text
https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-023-03140-5
Effective early diagnosis and treatment are of great significance to limit disease severity and prevent the occurrence and development of complications. […] The goal is to promptly initiate additional biologic or JAK pathway inhibitor therapies for these individuals in order to minimize disease activity and slow disease progression. […] CVD is one of the most common complications of RA and the leading cause of mortality for patients, accounting for 30-40% of deaths. […] The pathogenesis of RA-ILD has not been fully elucidated, which may be associated with endothelial dysfunction (ED) and atherosclerosis due to inflammation-associated loss of elasticity of the vascular wall. […] Compared with traditional risk factors for CVD, patients with RA are more likely to cause CVD due to disease activity, ESR, CRP, RF, and ACPA.
#27 Clinical prediction models of rheumatoid arthritis and its complications: focus on cardiovascular disease and interstitial lung disease | Arthritis Research & Therapy | Full Text
https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-023-03140-5
Therefore, current methods for assessing CVD risk tend to underestimate the risk when applied to patients with RA. […] An expanded risk score model for CVD in RA (ERS-RA) derived to predict 10-year probability of a CV event, such as MI, stroke, or CV-related death. […] The second major cause of death in patients with RA is respiratory disease, which occurs in 30-40% of patients. […] The diagnosis of RA-ILD proves difficult, because approximately 5-10% of patients have significant clinical signs, and an additional 20-30% may have subclinical RA-ILD.
#28 Clinical prediction models of rheumatoid arthritis and its complications: focus on cardiovascular disease and interstitial lung disease | Arthritis Research & Therapy | Full Text
https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-023-03140-5
Therefore, current methods for assessing CVD risk tend to underestimate the risk when applied to patients with RA. […] An expanded risk score model for CVD in RA (ERS-RA) derived to predict 10-year probability of a CV event, such as MI, stroke, or CV-related death. […] The second major cause of death in patients with RA is respiratory disease, which occurs in 30-40% of patients. […] The diagnosis of RA-ILD proves difficult, because approximately 5-10% of patients have significant clinical signs, and an additional 20-30% may have subclinical RA-ILD.
#29 Predictors of long-term prognosis in rheumatoid arthritis-related interstitial lung disease | Scientific Reports
https://www.nature.com/articles/s41598-022-13474-w
Our study has several limitations. […] While baseline age and RF predicted RA-ILD outcomes of progression versus no-progression, shifts in the level of CXCL11 and MMP-13 over 5 years were also correlated with long-term prognosis of RA-ILD. […] In multivariate analyses, baseline age as well as changes in levels of MMP-13 and CXCL11 were associated with the risk of progression of RA-ILD.
#30 Predictors of long-term prognosis in rheumatoid arthritis-related interstitial lung disease | Scientific Reports
https://www.nature.com/articles/s41598-022-13474-w
The aim of the study was to identify specific clinical and serum protein biomarkers that are associated with longitudinal outcome of RA-associated interstitial lung disease (RA-ILD). […] At Year 5, 32% of patients demonstrated progressive RA-ILD, 35% were stable, and 33% improved. […] Baseline age and rheumatoid factor (RF) were significantly different between RA-ILD outcomes of progression vs. no-progression (p<0.05). [...] Changes in levels of CXCL11/I-TAC and MMP13 over 5 years also distinguished pulmonary outcomes (p<0.05). [...] A final binary logistic regression model revealed that baseline age and changes in serum MMP13 as well as CXCL11/I-TAC were associated with RA-ILD progression at Year 5 (p<0.01), with an AUC of 0.7772. [...] Collectively, these analyses demonstrated that baseline clinical variables (age, RF) and shifts in levels of selected serum proteins (CXCL11/I-TAC, MMP13) were strongly linked to RA-ILD outcome over time.
#31 Machine learning-based prediction of relapse in rheumatoid arthritis patients using data on ultrasound examination and blood test | Scientific Reports
https://www.nature.com/articles/s41598-022-11361-y
Recent effective therapies enable most rheumatoid arthritis (RA) patients to achieve remission; however, some patients experience relapse. […] These results suggest that ML can provide an accurate prediction of relapse in RA patients, and the use of predictive algorithms may facilitate personalized treatment options. […] A combination of US examination and blood test data showed higher AUCs than those calculated using individual data. […] The result suggests that RFE uncovered an optimal combination of features for better prediction. […] Among the ten features selected by RFE in XGBoost, wrist and MTP SMI scores were the top two vital features, suggesting that US data significantly improved prediction of relapse in RA patients. […] The findings may lead to a better assessment of relapse risk and enable the selection of personalized treatment strategies for RA patients.
#32 Machine learning-based prediction of relapse in rheumatoid arthritis patients using data on ultrasound examination and blood test | Scientific Reports
https://www.nature.com/articles/s41598-022-11361-y
Recent effective therapies enable most rheumatoid arthritis (RA) patients to achieve remission; however, some patients experience relapse. […] These results suggest that ML can provide an accurate prediction of relapse in RA patients, and the use of predictive algorithms may facilitate personalized treatment options. […] A combination of US examination and blood test data showed higher AUCs than those calculated using individual data. […] The result suggests that RFE uncovered an optimal combination of features for better prediction. […] Among the ten features selected by RFE in XGBoost, wrist and MTP SMI scores were the top two vital features, suggesting that US data significantly improved prediction of relapse in RA patients. […] The findings may lead to a better assessment of relapse risk and enable the selection of personalized treatment strategies for RA patients.
#33 Machine learning-based prediction of relapse in rheumatoid arthritis patients using data on ultrasound examination and blood test | Scientific Reports
https://www.nature.com/articles/s41598-022-11361-y
Recent effective therapies enable most rheumatoid arthritis (RA) patients to achieve remission; however, some patients experience relapse. […] These results suggest that ML can provide an accurate prediction of relapse in RA patients, and the use of predictive algorithms may facilitate personalized treatment options. […] A combination of US examination and blood test data showed higher AUCs than those calculated using individual data. […] The result suggests that RFE uncovered an optimal combination of features for better prediction. […] Among the ten features selected by RFE in XGBoost, wrist and MTP SMI scores were the top two vital features, suggesting that US data significantly improved prediction of relapse in RA patients. […] The findings may lead to a better assessment of relapse risk and enable the selection of personalized treatment strategies for RA patients.
#34 Applying Data Mining Techniques for Predicting Prognosis in Patients with Rheumatoid Arthritis
https://www.mdpi.com/2227-9032/8/2/85
Applying Data Mining Techniques for Predicting Prognosis in Patients with Rheumatoid Arthritis […] Rheumatoid arthritis (RA) is a systematic chronic inflammatory disease. […] This study attempts to combine expert opinions to construct various classifiers using a number of data mining techniques to analyze the different prognosis of two patient groups, by predicting whether the inflammatory indicator erythrocyte sedimentation rates of these two groups will be within the normal range with different medication strategies. […] The results show the accuracy rate of the prediction model by Logistic, SVM and DT module were 0.7927, 07829 and 0.9094, respectively. […] The purpose of this study is to assist medical staff to make correct clinical decisions in the diseaseâs early stage by consideration of expert opinions, utilizing the data collected from a regional hospital in Taiwanâs Yunlin and Chiayi areas as the empirical basis, and various data mining techniques to predict the degree of inflammation and disease activity in patients without and with complications (cardiovascular diseases, hepatitis and ESRD) after treatment. […] Using data mining techniques to analyze patients without and with complications (cardiovascular diseases, hepatitis and ESRD) and to predict whether the ESR value will be within the normal range (refers to improvement of the degree of inflammation and corrosion of limbs). […] Using data mining techniques and logical regression analysis to predict the prognosis of RA patients. […] This study combined expert opinions to construct various classifiers based on the collected data by using data mining techniques to analyze whether the ESR value will be within the normal range in RA patients after treating with the four categories of drugs. […] The analysis results of the RA dataset are shown in Table 3. […] Our study shows that decision tree based techniques can be more efficient and accurate than other traditional and function based classifiers, and these decision-tree-based approaches could be widely adopted to assist clinicians in making better medication decisions. […] The contributions to this study are listed below. To the clinicians, who can utilize data mining techniques to predict RA prognosis so as to assist medical staff to make correct clinical decisions in the early stage.
#35 Applying Data Mining Techniques for Predicting Prognosis in Patients with Rheumatoid Arthritis
https://www.mdpi.com/2227-9032/8/2/85
Applying Data Mining Techniques for Predicting Prognosis in Patients with Rheumatoid Arthritis […] Rheumatoid arthritis (RA) is a systematic chronic inflammatory disease. […] This study attempts to combine expert opinions to construct various classifiers using a number of data mining techniques to analyze the different prognosis of two patient groups, by predicting whether the inflammatory indicator erythrocyte sedimentation rates of these two groups will be within the normal range with different medication strategies. […] The results show the accuracy rate of the prediction model by Logistic, SVM and DT module were 0.7927, 07829 and 0.9094, respectively. […] The purpose of this study is to assist medical staff to make correct clinical decisions in the diseaseâs early stage by consideration of expert opinions, utilizing the data collected from a regional hospital in Taiwanâs Yunlin and Chiayi areas as the empirical basis, and various data mining techniques to predict the degree of inflammation and disease activity in patients without and with complications (cardiovascular diseases, hepatitis and ESRD) after treatment. […] Using data mining techniques to analyze patients without and with complications (cardiovascular diseases, hepatitis and ESRD) and to predict whether the ESR value will be within the normal range (refers to improvement of the degree of inflammation and corrosion of limbs). […] Using data mining techniques and logical regression analysis to predict the prognosis of RA patients. […] This study combined expert opinions to construct various classifiers based on the collected data by using data mining techniques to analyze whether the ESR value will be within the normal range in RA patients after treating with the four categories of drugs. […] The analysis results of the RA dataset are shown in Table 3. […] Our study shows that decision tree based techniques can be more efficient and accurate than other traditional and function based classifiers, and these decision-tree-based approaches could be widely adopted to assist clinicians in making better medication decisions. […] The contributions to this study are listed below. To the clinicians, who can utilize data mining techniques to predict RA prognosis so as to assist medical staff to make correct clinical decisions in the early stage.
#36 Assessing prognosis and prediction of treatment response in early rheumatoid arthritis: systematic reviews – PubMed
https://pubmed.ncbi.nlm.nih.gov/30501821/
Rheumatoid arthritis (RA) is a chronic, debilitating disease associated with reduced quality of life and substantial costs. It is unclear which tests and assessment tools allow the best assessment of prognosis in people with early RA and whether or not variables predict the response of patients to different drug treatments. […] Review 1 – 22 model development studies and one combined model development/external validation study reporting 39 clinical prediction models were included. […] Review 2 – 12 studies were identified. Covariates examined included anti-citrullinated protein/peptide anti-body (ACPA) status, smoking status, erosions, rheumatoid factor status, C-reactive protein level, erythrocyte sedimentation rate, swollen joint count (SJC), body mass index and vascularity of synovium on power Doppler ultrasound (PDUS). Outcomes examined included erosions/radiographic progression, disease activity, physical function and Disease Activity Score-28 remission. There was statistical evidence to suggest that ACPA status, SJC and PDUS status at baseline may be treatment effect modifiers, but not necessarily that they are prognostic of response for all treatments. […] Review 1 – uncertainty remains over the optimal prediction model(s) for use in clinical practice. Review 2 – in general, there was insufficient evidence that the effect of treatment depended on baseline characteristics.
#37 Assessing prognosis and prediction of treatment response in early rheumatoid arthritis: systematic reviews – PubMed
https://pubmed.ncbi.nlm.nih.gov/30501821/
Rheumatoid arthritis (RA) is a chronic, debilitating disease associated with reduced quality of life and substantial costs. It is unclear which tests and assessment tools allow the best assessment of prognosis in people with early RA and whether or not variables predict the response of patients to different drug treatments. […] Review 1 – 22 model development studies and one combined model development/external validation study reporting 39 clinical prediction models were included. […] Review 2 – 12 studies were identified. Covariates examined included anti-citrullinated protein/peptide anti-body (ACPA) status, smoking status, erosions, rheumatoid factor status, C-reactive protein level, erythrocyte sedimentation rate, swollen joint count (SJC), body mass index and vascularity of synovium on power Doppler ultrasound (PDUS). Outcomes examined included erosions/radiographic progression, disease activity, physical function and Disease Activity Score-28 remission. There was statistical evidence to suggest that ACPA status, SJC and PDUS status at baseline may be treatment effect modifiers, but not necessarily that they are prognostic of response for all treatments. […] Review 1 – uncertainty remains over the optimal prediction model(s) for use in clinical practice. Review 2 – in general, there was insufficient evidence that the effect of treatment depended on baseline characteristics.
#38 On difficulties to define prognostic factors for clinical practice in rheumatoid arthritis | RMD Open
https://rmdopen.bmj.com/content/10/3/e004472
More generally, there does not appear to be any relationship between the presence of PPF and the outcome of the disease or response to treatment, as illustrated in the BeSt and IMPROVED therapeutic trials where the endpoint was damage progression which was prevented by the treatments received. […] It is important to note that the PPF used in the international recommendations may be different, since those defined by the American College of Rheumatology 2008 included extra-articular diseases. […] The choice of structural damage to define the prognosis of the disease is open to question, given the lack of relationship with function and quality of life. […] In this respect, the T2T concept has also been extended to other diseases, such as spondyloarthritis, psoriatic arthritis and, more recently, systemic lupus erythematosus.
#39 On difficulties to define prognostic factors for clinical practice in rheumatoid arthritis | RMD Open
https://rmdopen.bmj.com/content/10/3/e004472
More generally, there does not appear to be any relationship between the presence of PPF and the outcome of the disease or response to treatment, as illustrated in the BeSt and IMPROVED therapeutic trials where the endpoint was damage progression which was prevented by the treatments received. […] It is important to note that the PPF used in the international recommendations may be different, since those defined by the American College of Rheumatology 2008 included extra-articular diseases. […] The choice of structural damage to define the prognosis of the disease is open to question, given the lack of relationship with function and quality of life. […] In this respect, the T2T concept has also been extended to other diseases, such as spondyloarthritis, psoriatic arthritis and, more recently, systemic lupus erythematosus.
#40 (PDF) Assessing prognosis and prediction of treatment response in early rheumatoid arthritis: systematic reviews
https://www.academia.edu/52425671/Assessing_prognosis_and_prediction_of_treatment_response_in_early_rheumatoid_arthritis_systematic_reviews
Rheumatoid arthritis (RA) is a chronic, debilitating disease associated with reduced quality of life and substantial costs. It is unclear which tests and assessment tools allow the best assessment of prognosis in people with early RA and whether or not variables predict the response of patients to different drug treatments. […] The strongest age and sex adjusted baseline predictors of DAS28-ESR remission at 12-24 months were remission at baseline (odds ratio [OR]: 4.49, 95% CI: 2.17-9.29, P 0.001), being male (OR: 2.42, 95% CI: 1.46-4.01, P 0.001), abstaining from alcohol (P 0.001) and being lower weight (OR: 0.98, 95% CI: 0.97-1.00, P = 0.015). […] In this observational study, patients with early RA at risk of not achieving remission include those with high disease activity at baseline, women, those who drink alcohol and those with higher body weight.
#41 Diagnosis, prognosis and classification of early arthritis: results of a systematic review informing the 2016 update of the EULAR recommendations for the management of early arthritis
https://pmc.ncbi.nlm.nih.gov/articles/PMC5237764/
Patients with EA referred to a rheumatologist within 3 months show better outcomes than those with later referral. […] Structural damage on baseline X-rays of hands and feet is predictive of further radiographic progression in patients with EA. […] This systematic literature review (SLR) highlights the importance of early referral of patients with EA to the rheumatologist and confirms that the RF and mainly ACPAs serological status, as well as the radiographic status, are of value in the diagnosis and prognosis of patients with EA. […] RF and ACPAs are useful tests in patients with EA but ACPAs have more diagnostic and prognostic value than RF. […] Our results, as well as evidence from previously published literature, clearly supports the need for early referral (ideally within 3 months of symptom onset) of patients with EA to a rheumatologist, in order to reduce the likelihood of joint damage and to improve clinical outcomes. […] Prognostic values of RF and ACPAs in terms of predicting radiographic progression were very dependent on the prevalence of radiographic progression in the studies but NPVs were in general higher for ACPAs (around 80%) than for RF.
#42 (PDF) Assessing prognosis and prediction of treatment response in early rheumatoid arthritis: systematic reviews
https://www.academia.edu/52425671/Assessing_prognosis_and_prediction_of_treatment_response_in_early_rheumatoid_arthritis_systematic_reviews
The progression of rheumatoid arthritis (RA) is quite variable, ranging from very mild or subclinical forms (approx. 10%) to rapidly progressing and debilitating forms (10-15%). […] To optimise the therapeutic management of early RA it is necessary to perform periodic evaluations of the clinical and laboratory test responses to the treatment instituted, as well as the parameters indicating disease prognosis. […] The HAQ score during the first three months predicted disability at 10 years with an odds ratio of 13.4. […] Prospective studies such as this give important knowledge of the variable long term prognosis of RA and provide necessary background information for clinical trials of new treatment modalities. […] The use of quantitative measures to analyse the long-term course of RA appears to have provided new insights into the severe morbidity and increased mortality rates of this disease.
#43 On difficulties to define prognostic factors for clinical practice in rheumatoid arthritis | RMD Open
https://rmdopen.bmj.com/content/10/3/e004472
However, the identification of predictive factors of therapeutic response is of great interest if we want to offer the right treatment to the right patient at the right time, thus avoiding prolonged periods of disease activity, which are a source of progression of structural damage, and reducing the risk of progression to a disease that is difficult to treat. […] The results of the R4RA and STRAP studies demonstrate the value of stratifying patients according to synovial pathotypes to predict response to tocilizumab and rituximab. […] When the patient is in persistent remission, it is advisable to try to taper or even to discontinue the current DMARD. […] As a result, a large number of PPF have been identified, but their relevance remains questionable due to limited replication, with the exception of a few (disease duration, time to achieve remission on bDMARD (bDMARD, biologic disease-modifying antirheumatic drugs), etc).
#44 Clinical prediction models of rheumatoid arthritis and its complications: focus on cardiovascular disease and interstitial lung disease | Arthritis Research & Therapy | Full Text
https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-023-03140-5
Effective early diagnosis and treatment are of great significance to limit disease severity and prevent the occurrence and development of complications. […] The goal is to promptly initiate additional biologic or JAK pathway inhibitor therapies for these individuals in order to minimize disease activity and slow disease progression. […] CVD is one of the most common complications of RA and the leading cause of mortality for patients, accounting for 30-40% of deaths. […] The pathogenesis of RA-ILD has not been fully elucidated, which may be associated with endothelial dysfunction (ED) and atherosclerosis due to inflammation-associated loss of elasticity of the vascular wall. […] Compared with traditional risk factors for CVD, patients with RA are more likely to cause CVD due to disease activity, ESR, CRP, RF, and ACPA.
#45 Pretreatment Prediction of Individual Rheumatoid Arthritis Patientsâ Response to Anti-Cytokine Therapy Using Serum Cytokine/Chemokine/Soluble Receptor Biomarkers | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0132055
Multiple linear regression and multiple logistic regression analyses identified biomarkers that were predictive of remission/non-remission in tocilizumab and etanercept therapy. […] We discovered biomarkers in RA pretreatment serum that predicted their week 16 DAS28-CRP score and clinical outcome to tocilizumab therapy. […] We believe that identifying reliable predictive biomarkers will make it easier to follow EULARs treat-to-target recommendation by allowing clinicians to know in advance if a treatment strategy will achieve the treatment goal (target) that has been pre-determined for each RA patient. […] We believe that making a prediction before therapy using blood serum may be possible because patients serum cytokine/chemokine levels tend to reflect patients disease and genetic status.
#46 Pretreatment Prediction of Individual Rheumatoid Arthritis Patientsâ Response to Anti-Cytokine Therapy Using Serum Cytokine/Chemokine/Soluble Receptor Biomarkers | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0132055
In this study we used a Luminix beads based array method to measure and analyze cytokines/chemokines simultaneously in RA patients pretreatment serum to identify biomarkers that could predict each patients response and outcome before therapy. […] We believe that the predictive biomarkers we identified through quantifying cytokines/chemokines/soluble receptors are more practical and useful than gene analysis. […] These biomarkers may assist doctors to identify in advance patients who will not respond favorably to a treatment protocol thereby sparing patients from being treated with expensive and powerful agents that are not efficacious for them.