Document Detail


Performance of matrix-based risk models for rapid radiographic progression in a cohort of patients with established rheumatoid arthritis.
MedLine Citation:
PMID:  23044765     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: 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.
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 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.
RESULTS: 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 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.
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:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Arthritis care & research     Volume:  65     ISSN:  2151-4658     ISO Abbreviation:  Arthritis Care Res (Hoboken)     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-04-04     Completed Date:  2013-05-21     Revised Date:  2014-04-02    
Medline Journal Info:
Nlm Unique ID:  101518086     Medline TA:  Arthritis Care Res (Hoboken)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  526-33     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 by the American College of Rheumatology.
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MeSH Terms
Descriptor/Qualifier:
Aged
Arthritis, Rheumatoid / radiography*
Disease Progression
Female
Humans
Male
Middle Aged
Predictive Value of Tests
Prognosis
Regression Analysis
Risk Assessment / methods*
Risk Factors
Grant Support
ID/Acronym/Agency:
1RC2AR058989-01/AR/NIAMS NIH HHS; K24 AR055989/AR/NIAMS NIH HHS; K24-AR-055989/AR/NIAMS NIH HHS
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