Maintenance to target was associated with radiological outcomes in patients with rheumatoid arthritis: a real-world obse
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ORIGINAL ARTICLE
Maintenance to target was associated with radiological outcomes in patients with rheumatoid arthritis: a real-world observational cohort study Lanlan Ji 1
&
Wenhui Xie 1 & Guangtao Li 1 & Zhuoli Zhang 1
Received: 22 May 2020 / Revised: 22 July 2020 / Accepted: 31 August 2020 # International League of Associations for Rheumatology (ILAR) 2020
Abstract Objective To investigate the effect of different maintenance to target on radiologic outcomes in patients with rheumatoid arthritis (RA) in real-world setting. Methods RA patients enrolled were screened from a longitudinal cohort. The radiographies were evaluated at baseline, after 1–2 years and thereafter every 2 years. An increase of mTSS > 3 from baseline was taken as the primary outcome and accelerated annual radiological progression as the secondary outcome of radiological progression. The maintenance rate (MR) to target was calculated as the proportion of the year fulfilling preset criteria of target over the whole follow-up period. COX regression and logistic analysis were used to determine the effect of variables on radiological outcomes. Results Two hundred forty-three patients were enrolled, with median follow-up of 2 years (3.00). Radiological progression was observed in 43 (17.7%) patients, with annual increase of mTSS 0.20 (1.33). In multivariate analysis, MR was the only independent protective factor of both primary and secondary radiological outcomes in two models [HR 0.09, 95% CI (0.04, 0.22), p < 0.001, model 1; OR 0.21, 95% CI (0.09, 0.49), p < 0.001, model 2]. ACPA positivity was another independent risk factor of secondary outcome [OR 2.96, 95% CI (1.27, 6.86), p = 0.012]. Higher MR was also associated with less radiological progression in established RA patients. Partial MR was not inferior to full maintenance within 4 years in terms of halting radiological progression. Conclusion Low MR and ACPA positivity were independent risk factors of poor radiological outcomes in RA patients. No significant difference in radiological progression could be detected between partial and full maintenance group within 4 years in daily practice. Key Points • The first study showing that maintenance to target is beneficial to bone protection in established RA patients in real-world setting. • No difference in radiological outcomes between partial and full maintenance group within 4 years.
Keywords Maintenance to target . Radiological outcome . Rheumatoid arthritis
Background Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10067-020-05385-w) contains supplementary material, which is available to authorized users. * Zhuoli Zhang [email protected] 1
Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No.8, Xishiku Street West District, Beijing, China
The key pathological features of rheumatoid arthritis (RA) are synovitis and subsequent bone erosion, leading to permanent disability and impaired quality of life. Conventional risk factors of bone erosion include h
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