Characterization of disease course and remission in early seropositive rheumatoid arthritis: results from the TACERA longitudinal cohort study

RA-MAP Consortium

doi:10.1177/1759720X211043977

Characterization of disease course and remission in early seropositive rheumatoid arthritis: results from the TACERA longitudinal cohort study

RA-MAP Consortium

Inflammation and Ageing

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Abstract

Background: To characterise disease course and remission in a longitudinal observational study of newly diagnosed, initially treatment-naïve patients with seropositive rheumatoid arthritis (RA). Methods: Patients with early untreated seropositive RA were recruited from 28 UK centres. Multiple clinical and laboratory measures were collected every 3 months for up to 18 months. Disease activity was measured using the 28-joint Disease Activity Score with C-reactive protein (DAS28-CRP) and Simplified Disease Activity Index (SDAI). Logistic regression models examined clinical predictors of 6-month remission and latent class mixed models characterised disease course. Results: We enrolled 275 patients of whom 267 met full eligibility and provided baseline data. According to SDAI definition, 24.3% attained 6-month remission. Lower baseline Health Assessment Questionnaire (HAQ) and SDAI predicted 6-month remission (p = 0.013 and 0.011). Alcohol intake and baseline prescribing of methotrexate with a second disease-modifying antirheumatic drug (DMARD; vs monotherapy without glucocorticoids) were also predictive. Three distinct SDAI trajectory subpopulations emerged; corresponding to an inadequate responder group (6.5%), and higher and lower baseline activity responder groups (22.4% and 71.1%). Baseline HAQ and Short Form-36 Health Survey – Mental Component Score (SF-36 MCS) distinguished these groups. In addition, a number of baseline clinical predictors correlated with disease activity severity within subpopulations. Beneficial effects of alcohol intake were found across subpopulations. Conclusion: Three distinct disease trajectory subpopulations were identified. Differential effects of functional and mental well-being, alcohol consumption, and baseline RA medication prescribing on disease activity severity were found across subpopulations. Heterogeneity across trajectories cannot be fully explained by baseline clinical predictors. We hypothesise that biological markers collected early in disease course (within 6 months) may help patient management and better targeting of existing and novel therapies.

Original language	English
Pages (from-to)	1–17
Number of pages	17
Journal	Therapeutic Advances in Musculoskeletal Disease
Volume	13
DOIs	https://doi.org/10.1177/1759720X211043977
Publication status	Published - 21 Oct 2021

Bibliographical note

Funding Information:
The author acknowledges the support of TACERA Principal Investigators from all contributing NHS sites and the members of the TACERA Study Steering and Data Monitoring Committee. This research was supported by the NIHR Newcastle Biomedical Research Centre and the NIHR Cambridge Biomedical Research Centre. (The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care) Members of the RA-MAP Consortium can be found in the supplementary document “RA-MAP Consortium Membership.docx”.

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by the MRC/ABPI Inflammation and Immunology Initiative Grant (MRC reference numbers: G1001516 and G1001518). Dr Brian Tom is supported by the UK Medical Research Council (Unit Programme number MC_UP_1302/3 and MC_UU_00002/2).

Publisher Copyright:
© The Author(s), 2021.

Keywords

disease activity
latent class–mixed models
remission
rheumatoid arthritis
SDAI trajectories

ASJC Scopus subject areas

Rheumatology
Orthopedics and Sports Medicine

Access to Document

10.1177/1759720X211043977Licence: Creative Commons: Attribution (CC BY)

BarnesM2021Characterization Final published version, 652 KBLicence: Creative Commons: Attribution (CC BY)

An Immunological Toolkit for Clinical Application - WP2 - RA-MAP
Buckley, C., Raza, K., Fisher, B. & Young, S.
Medical Research Council
6/02/12 → 5/08/17
Project: Research Councils

Cite this

@article{96888c7753134082acb98dc3db482305,

title = "Characterization of disease course and remission in early seropositive rheumatoid arthritis: results from the TACERA longitudinal cohort study",

abstract = "Background: To characterise disease course and remission in a longitudinal observational study of newly diagnosed, initially treatment-na{\"i}ve patients with seropositive rheumatoid arthritis (RA). Methods: Patients with early untreated seropositive RA were recruited from 28 UK centres. Multiple clinical and laboratory measures were collected every 3 months for up to 18 months. Disease activity was measured using the 28-joint Disease Activity Score with C-reactive protein (DAS28-CRP) and Simplified Disease Activity Index (SDAI). Logistic regression models examined clinical predictors of 6-month remission and latent class mixed models characterised disease course. Results: We enrolled 275 patients of whom 267 met full eligibility and provided baseline data. According to SDAI definition, 24.3% attained 6-month remission. Lower baseline Health Assessment Questionnaire (HAQ) and SDAI predicted 6-month remission (p = 0.013 and 0.011). Alcohol intake and baseline prescribing of methotrexate with a second disease-modifying antirheumatic drug (DMARD; vs monotherapy without glucocorticoids) were also predictive. Three distinct SDAI trajectory subpopulations emerged; corresponding to an inadequate responder group (6.5%), and higher and lower baseline activity responder groups (22.4% and 71.1%). Baseline HAQ and Short Form-36 Health Survey – Mental Component Score (SF-36 MCS) distinguished these groups. In addition, a number of baseline clinical predictors correlated with disease activity severity within subpopulations. Beneficial effects of alcohol intake were found across subpopulations. Conclusion: Three distinct disease trajectory subpopulations were identified. Differential effects of functional and mental well-being, alcohol consumption, and baseline RA medication prescribing on disease activity severity were found across subpopulations. Heterogeneity across trajectories cannot be fully explained by baseline clinical predictors. We hypothesise that biological markers collected early in disease course (within 6 months) may help patient management and better targeting of existing and novel therapies.",

keywords = "disease activity, latent class–mixed models, remission, rheumatoid arthritis, SDAI trajectories",

author = "{RA-MAP Consortium} and Michael Barnes and Sarah Brockbank and Bruce, {Ian N} and Coziana Ciurtin and Cop, {Andrew P} and Ehrenstein, {Michael R} and Paul Emery and Fisher, {Benjamin A} and John Isaacs and Ruth Matthews and McInnes, {Iain B} and Hayley Noble and Pedersen, {Ayako Wakatsuki} and Constantino Pitzalis and Karim Raza and Anthony Rowe and Gemma Simpson and Dominic Stringer and Taylor, {Peter C} and Brian Tom and Yujie Zhong",

note = "Funding Information: The author acknowledges the support of TACERA Principal Investigators from all contributing NHS sites and the members of the TACERA Study Steering and Data Monitoring Committee. This research was supported by the NIHR Newcastle Biomedical Research Centre and the NIHR Cambridge Biomedical Research Centre. (The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care) Members of the RA-MAP Consortium can be found in the supplementary document “RA-MAP Consortium Membership.docx”. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by the MRC/ABPI Inflammation and Immunology Initiative Grant (MRC reference numbers: G1001516 and G1001518). Dr Brian Tom is supported by the UK Medical Research Council (Unit Programme number MC_UP_1302/3 and MC_UU_00002/2). Publisher Copyright: {\textcopyright} The Author(s), 2021.",

year = "2021",

month = oct,

day = "21",

doi = "10.1177/1759720X211043977",

language = "English",

volume = "13",

pages = "1–17",

journal = "Therapeutic Advances in Musculoskeletal Disease",

issn = "1759-720X",

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TY - JOUR

T1 - Characterization of disease course and remission in early seropositive rheumatoid arthritis

T2 - results from the TACERA longitudinal cohort study

AU - RA-MAP Consortium

AU - Barnes, Michael

AU - Brockbank, Sarah

AU - Bruce, Ian N

AU - Ciurtin, Coziana

AU - Cop, Andrew P

AU - Ehrenstein, Michael R

AU - Emery, Paul

AU - Fisher, Benjamin A

AU - Isaacs, John

AU - Matthews, Ruth

AU - McInnes, Iain B

AU - Noble, Hayley

AU - Pedersen, Ayako Wakatsuki

AU - Pitzalis, Constantino

AU - Raza, Karim

AU - Rowe, Anthony

AU - Simpson, Gemma

AU - Stringer, Dominic

AU - Taylor, Peter C

AU - Tom, Brian

AU - Zhong, Yujie

N1 - Funding Information: The author acknowledges the support of TACERA Principal Investigators from all contributing NHS sites and the members of the TACERA Study Steering and Data Monitoring Committee. This research was supported by the NIHR Newcastle Biomedical Research Centre and the NIHR Cambridge Biomedical Research Centre. (The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care) Members of the RA-MAP Consortium can be found in the supplementary document “RA-MAP Consortium Membership.docx”. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by the MRC/ABPI Inflammation and Immunology Initiative Grant (MRC reference numbers: G1001516 and G1001518). Dr Brian Tom is supported by the UK Medical Research Council (Unit Programme number MC_UP_1302/3 and MC_UU_00002/2). Publisher Copyright: © The Author(s), 2021.

PY - 2021/10/21

Y1 - 2021/10/21

N2 - Background: To characterise disease course and remission in a longitudinal observational study of newly diagnosed, initially treatment-naïve patients with seropositive rheumatoid arthritis (RA). Methods: Patients with early untreated seropositive RA were recruited from 28 UK centres. Multiple clinical and laboratory measures were collected every 3 months for up to 18 months. Disease activity was measured using the 28-joint Disease Activity Score with C-reactive protein (DAS28-CRP) and Simplified Disease Activity Index (SDAI). Logistic regression models examined clinical predictors of 6-month remission and latent class mixed models characterised disease course. Results: We enrolled 275 patients of whom 267 met full eligibility and provided baseline data. According to SDAI definition, 24.3% attained 6-month remission. Lower baseline Health Assessment Questionnaire (HAQ) and SDAI predicted 6-month remission (p = 0.013 and 0.011). Alcohol intake and baseline prescribing of methotrexate with a second disease-modifying antirheumatic drug (DMARD; vs monotherapy without glucocorticoids) were also predictive. Three distinct SDAI trajectory subpopulations emerged; corresponding to an inadequate responder group (6.5%), and higher and lower baseline activity responder groups (22.4% and 71.1%). Baseline HAQ and Short Form-36 Health Survey – Mental Component Score (SF-36 MCS) distinguished these groups. In addition, a number of baseline clinical predictors correlated with disease activity severity within subpopulations. Beneficial effects of alcohol intake were found across subpopulations. Conclusion: Three distinct disease trajectory subpopulations were identified. Differential effects of functional and mental well-being, alcohol consumption, and baseline RA medication prescribing on disease activity severity were found across subpopulations. Heterogeneity across trajectories cannot be fully explained by baseline clinical predictors. We hypothesise that biological markers collected early in disease course (within 6 months) may help patient management and better targeting of existing and novel therapies.

AB - Background: To characterise disease course and remission in a longitudinal observational study of newly diagnosed, initially treatment-naïve patients with seropositive rheumatoid arthritis (RA). Methods: Patients with early untreated seropositive RA were recruited from 28 UK centres. Multiple clinical and laboratory measures were collected every 3 months for up to 18 months. Disease activity was measured using the 28-joint Disease Activity Score with C-reactive protein (DAS28-CRP) and Simplified Disease Activity Index (SDAI). Logistic regression models examined clinical predictors of 6-month remission and latent class mixed models characterised disease course. Results: We enrolled 275 patients of whom 267 met full eligibility and provided baseline data. According to SDAI definition, 24.3% attained 6-month remission. Lower baseline Health Assessment Questionnaire (HAQ) and SDAI predicted 6-month remission (p = 0.013 and 0.011). Alcohol intake and baseline prescribing of methotrexate with a second disease-modifying antirheumatic drug (DMARD; vs monotherapy without glucocorticoids) were also predictive. Three distinct SDAI trajectory subpopulations emerged; corresponding to an inadequate responder group (6.5%), and higher and lower baseline activity responder groups (22.4% and 71.1%). Baseline HAQ and Short Form-36 Health Survey – Mental Component Score (SF-36 MCS) distinguished these groups. In addition, a number of baseline clinical predictors correlated with disease activity severity within subpopulations. Beneficial effects of alcohol intake were found across subpopulations. Conclusion: Three distinct disease trajectory subpopulations were identified. Differential effects of functional and mental well-being, alcohol consumption, and baseline RA medication prescribing on disease activity severity were found across subpopulations. Heterogeneity across trajectories cannot be fully explained by baseline clinical predictors. We hypothesise that biological markers collected early in disease course (within 6 months) may help patient management and better targeting of existing and novel therapies.

KW - disease activity

KW - latent class–mixed models

KW - remission

KW - rheumatoid arthritis

KW - SDAI trajectories

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U2 - 10.1177/1759720X211043977

DO - 10.1177/1759720X211043977

M3 - Article

AN - SCOPUS:85131371676

SN - 1759-720X

VL - 13

SP - 1

EP - 17

JO - Therapeutic Advances in Musculoskeletal Disease

JF - Therapeutic Advances in Musculoskeletal Disease

ER -

Characterization of disease course and remission in early seropositive rheumatoid arthritis: results from the TACERA longitudinal cohort study

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

Access to Document

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Projects

An Immunological Toolkit for Clinical Application - WP2 - RA-MAP

Cite this