Towards personalized treatment: predictors of short-term HAQ response in recent-onset active rheumatoid arthritis are different from predictors of rapid radiological progression

Abstract

Objective: Personalized treatment depends on the treatment goals. Current prediction models to guide initial treatment choices focus on radiological damage progression. However, for some patients this outcome is less relevant, whereas short-term functional ability is relevant to all. Do these various treatment goals share the same predictors?

Methods: Data for 497 patients from the Dutch Behandel Strategieen (BeSt) study of treatment strategies for early rheumatoid arthritis (RA), randomized to initial monotherapy or combination therapy, were used. Predictors of short-term functional disability [Health Assessment Questionnaire (HAQ) score ≥ 1 after 3 months of treatment] were identified with logistic regression analyses. Predicted risks of a HAQ score ≥ 1 were determined for each treatment group and for each subpopulation.

Results: At baseline, 76% of patients had a HAQ score ≥ 1 (mean 1.7 ± 0.5). After 3 months of treatment this score was achieved by 40% (mean HAQ score 1.5 ± 0.5). Baseline HAQ score, pain, the Ritchie Articular Index (RAI), and treatment group were significant independent predictors for a HAQ score ≥ 1; the presence of rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP) antibodies, and baseline radiological damage were not. With cut-offs of 35% and 60%, the risk of a HAQ score ≥ 1 was high for 47% and low for 20% of the patients treated with initial monotherapy. Risks were markedly reduced in the combination therapy groups, also in unfavourable risk profiles.

Conclusion: In recent-onset active RA, baseline HAQ score, pain, and initial treatment are predictors for a HAQ score ≥ 1 after 3 months. Known predictors of radiological damage were not predictive of short-term functional disability. The choice of the best initial treatment thus depends on the relevance of various outcome measures for an individual patient.

Acknowledgements

We thank all of the participating patients and the following rheumatologists (other than the authors) who participated in the Foundation for Applied Rheumatology Research (all locations are in The Netherlands): WM de Beus (Medical Centre Haaglanden, Leidschendam); C Bijkerk (Reinier de Graaf Gasthuis, Delft); MHW de Bois (Medical Centre Haaglanden, The Hague); FC Breedveld (Leiden University Medical Centre, Leiden); G Collée (Medical Centre Haaglanden, The Hague); JAPM Ewals (Haga Hospital, The Hague); AH Gerards (Vlietland Hospital, Schiedam); BAM Grillet (De Honte Hospital, Terneuzen); JHLM van Groenendael (Franciscus Hospital, Roosendaal); KH Han (Medical Centre Rijnmond-Zuid, Rotterdam); JMW Hazes (Erasmus University Medical Centre, Rotterdam); HMJ Hulsmans (Haga Hospital, The Hague); MH de Jager (Albert Schweitzer Hospital, Dordrecht); JM de Jonge-Bok (retired); MV van Krugten (Walcheren Hospital, Vlissingen); H van der Leeden (retired); WF Lems (VU Medical Centre, Amsterdam); MF van Lieshout-Zuidema (Spaarne Hospital, Hoofddorp); A Linssen (retired); PAHM van der Lubbe (Vlietland Hospital, Schiedam); C Mallée (Kennemer Gasthuis, Haarlem); ETH Molenaar (Groene Hart Hospital, Gouda); HC van Paassen (Sint Franciscus Gasthuis, Rotterdam); AJ Peeters (Reinier de Graaf Gasthuis, Delft); HK Markusse (deceased); RM van Soesbergen (retired); PBJ de Sonnaville (Oosterschelde Hospital, Goes); I Speyer (Bronovo Hospital, The Hague); KSS Steen (Kennemer Gasthuis, Haarlem); J Ph Terwiel (Spaarne Hospital, Hoofddorp); AE Voskuyl (VU Medical Centre, Amsterdam); ML Westedt (Bronovo Hospital, The Hague); S ten Wolde (Kennemer Gasthuis, Haarlem); JMGW Wouters (Sint Franciscus Gasthuis, Rotterdam); and D van Zeben (Sint Franciscus Gasthuis, Rotterdam). We also thank all of the other rheumatologists and trainee rheumatologists who enrolled patients in this study, and all research nurses for their contributions.

The BeSt study was supported by the Dutch College of Health Insurances. Schering-Plough and Centocor provided additional funding.

Supporting Information

Additional Supporting Information may be found in the online version of this article.S1 and S2 contain supplemental tables.S3 contains a supplementary figure.Please note: The editors are not responsible for the content or functionality of any supporting materials supplied by the authors. Any queries shouldbe directed to the corresponding author for the article.