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[How frequent are poor prognostic markers in rheumatoid arthritis? : An estimate based on three epidemiologic cohorts].
- Source :
-
Zeitschrift fur Rheumatologie [Z Rheumatol] 2017 Jun; Vol. 76 (5), pp. 434-442. - Publication Year :
- 2017
-
Abstract
- Background: Unfavorable prognostic factors-high disease activity, early erosions, and autoantibodies-should be considered when making treatment decisions in rheumatoid arthritis (RA). There are little data on the frequency of individual poor prognostic factors among RA patients in daily care.<br />Methods: Disease activity (Disease Activity Score, DAS28), erosions, antibodies against citrullinated peptides or rheumatoid factor (ACPA/RF+), previous treatment failure, inflammation markers, and functional disability (FFbH < 70) were defined as prognostic factors. Different treatment decision making situations were evaluated in disease-modifying antirheumatic drug (DMARD)-naïve patients from the early RA CAPEA cohort (n = 1059), and in patients from the biologics register RABBIT after failure of one (n = 2217) or more (n = 3280) conventional synthetic (cs)DMARDs or one (n = 1134) or more (n = 795) biologic (b)DMARDs. With the national database of German arthritis centers (NDB), the frequency of these factors was analyzed according to treatment strata (no/1 <superscript>st</superscript> /2 <superscript>nd</superscript> /3 <superscript>rd</superscript> DMARD; n = 5707).<br />Results: In DMARD-naïve patients (CAPEA), 50% presented with DAS28 > 5.1, 64% were ACPA/RF+, 13% had erosions, and 37% functional disability (FFbH < 70). In RABBIT, 63 (1 <superscript>st</superscript> csDMARD failure) to 81% (≥2 bDMARD failures) were ACPA/RF+, 29 to 70% had erosions, 33 to 52% DAS28 > 5.1, and 41 to 66% had FFbH < 70, respectively. In the NDB, between 47 (DMARD-naïve) and 82% (≥2 previous DMARDs) were ACPA/RF+, 5 to 11%, had high disease activity under treatment (DAS28 > 5.1), and 26 to 50% had functional disability (FFbH < 70), respectively.<br />Conclusion: With growing numbers of previous DMARD therapies, increasing proportions of patients have poor prognostic factors. This underlines the importance of these factors for a difficult-to-treat disease course.
Details
- Language :
- German
- ISSN :
- 1435-1250
- Volume :
- 76
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Zeitschrift fur Rheumatologie
- Publication Type :
- Academic Journal
- Accession number :
- 28429118
- Full Text :
- https://doi.org/10.1007/s00393-017-0306-4