Hand-dominant joint involvement pattern associates with favourable, and polyarthritis with unfavourable, treatment response to both csDMARDs and bDMARDs in early rheumatoid arthritis
a combined analysis of NORD-STAR and BeSt trials
Yasuo Nagafuchi (Leiden University Medical Center)
Tjardo D. Maarseveen (Leiden University Medical Center)
Kristina Lend (Karolinska Institutet, Universiteit van Amsterdam)
Anna Rudin (University of Gothenburg, Sahlgrenska University Hospital/Östra)
Bjorn Gudbjornsson (University of Iceland, Landspitali University Hospital)
Dan Nordström (Viikki Biocenter 1, Helsinki University Central Hospital)
Espen A. Haavardsholm (Diakonhjemmet Hospital)
Erik B. van den Akker (TU Delft - Pattern Recognition and Bioinformatics, Leiden University Medical Center)
Rachel Knevel (Newcastle University School of Clinical Medical Sciences, TU Delft - Pattern Recognition and Bioinformatics, Leiden University Medical Center)
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Abstract
Objectives: To investigate the association between joint involvement pattern (JIP) subgroups and treatment responses to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and biological disease-modifying antirheumatic drugs (bDMARDs), and to compare the impact of JIP subgroups with other clinical parameters in treatment-naïve patients with early rheumatoid arthritis (RA). Methods: An individual patient data meta-analysis was conducted using 2 randomised controlled trials, NOrdic Rheumatic Diseases Strategy Trials And Registries (NORD-STAR) and Behandel-Strategieën (BeSt), including 1250 treatment-naïve patients with early RA. JIP subgroup assignment was based on 4 previously identified subgroups defined by baseline clinical characteristics, primarily joint involvement in the 66/68 joint scheme. Treatment outcomes were measured using the longitudinal Clinical Disease Activity Index (CDAI) and other disease activity indices through week 48. Associations of the JIP subgroups and other clinical predictors were evaluated using a mixed-model analysis. Results: Patients with a hand-dominant JIP (JIP-Hand) showed significantly better CDAI scores after treatment (Beta for CDAI = −1.4 [95% CI, −2.3 to −0.55]; p = .0016), whereas those with a polyarthritis pattern (JIP-Poly) exhibited worse outcomes (Beta = 0.95 [95% CI, 0.064-1.8]; p = .035). Female sex was also associated with worse CDAI scores (Beta = 1.2 [95% CI, 0.40-2.0]; p = .0031), whereas anticitrullinated protein antibodies did not show a significant association (Beta = 0.19 [95% CI, −0.69 to 1.1]; p = .67). When compared across groups, csDMARDs and combined bDMARDs were similarly effective in the respective JIP subgroups (interaction p > .10). Conclusions: In early RA, csDMARD and bDMARD treatments resulted in the greatest improvement in disease activity in JIP-Hand and the least improvement in JIP-Poly.
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