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The performance of matrix-based risk models for rapid radiographic progression in BRASS, a cohort of patients with established rheumatoid arthritis.
MedLine Citation:
PMID:  23044765     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVES.: 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 three risk models for RRP in an observational cohort. METHODS.: 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 van der Heijde-Sharp score of ò 5 units. Patients were placed in the appropriate matrix categories, with a corresponding predicted risk of RRP. The mean predicted probability for cases and non-cases, integrated discrimination improvement, Hosmer-Lemeshow statistics and the c-statistics were calculated. RESULTS.: The median (IQR) age was 59 (50, 66) years, disease duration 12 (4, 23) years and swollen joint count 6 (2, 13), 84% were female and 86% had erosions at baseline. Twelve percent (32/271) of patients treated with synthetic DMARDs at baseline and 10% (21/207) of patients 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 the BRASS cohort, with c-statistics of 0.59 (model A), 0.65 (model B) and 0.57 (model C) and Hosmer-Lemeshow chi-square p-values of 0.06 (model A), 0.005 (model B) and 0.05 (model C). CONCLUSION.: 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. © 2012 by the American College of Rheumatology.
Authors:
Siri Lillegraven; Nina Paynter; Femke H M Prince; Nancy A Shadick; Espen A Haavardsholm; Michelle L Frits; Christine K Iannaccone; Tore K Kvien; Michael E Weinblatt; Daniel H Solomon
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-10-8
Journal Detail:
Title:  Arthritis care & research     Volume:  -     ISSN:  2151-4658     ISO Abbreviation:  Arthritis Care Res (Hoboken)     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-9     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101518086     Medline TA:  Arthritis Care Res (Hoboken)     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 by the American College of Rheumatology.
Affiliation:
Division of Rheumatology, Brigham and Women's Hospital, Boston, MA, USA; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. siri.lillegraven@gmail.com.
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