Dr. Shadick has received research grants from Crescendo Bioscience, MedImmune, Abbott, Amgen, and Genentech. Ms Iannaccone has received salary support from Biogen Idec, MedImmune, and Crescendo Bioscience.
Performance of Matrix-Based Risk Models for Rapid Radiographic Progression in a Cohort of Patients With Established Rheumatoid Arthritis
Article first published online: 28 MAR 2013
Copyright © 2013 by the American College of Rheumatology
Arthritis Care & Research
Volume 65, Issue 4, pages 526–533, April 2013
How to Cite
Lillegraven, S., Paynter, N., Prince, F. H. M., Shadick, N. A., Haavardsholm, E. A., Frits, M. L., Iannaccone, C. K., Kvien, T. K., Weinblatt, M. E. and Solomon, D. H. (2013), Performance of Matrix-Based Risk Models for Rapid Radiographic Progression in a Cohort of Patients With Established Rheumatoid Arthritis. Arthritis Care Res, 65: 526–533. doi: 10.1002/acr.21870
- Issue published online: 28 MAR 2013
- Article first published online: 28 MAR 2013
- Accepted manuscript online: 8 OCT 2012 12:12PM EST
- Manuscript Accepted: 28 SEP 2012
- Manuscript Received: 2 JUL 2012
- Biogen Idec, MedImmune, and Crescendo Bioscience
- South-Eastern Norway Regional Health Authority
- Niels Stensen Foundation, The Netherlands
- NIH. Grant Numbers: K24-AR-055989, 1RC2AR058989-01
Matrix-based risk models have been proposed as a tool to predict rapid radiographic progression (RRP) in rheumatoid arthritis (RA), but the experience with such models is limited. We tested the performance of 3 risk models for RRP in an observational cohort.
Subjects from an observational RA cohort with hand radiographs and necessary predictor variables to be classified by the risk models were identified (n = 478). RRP was defined as a yearly change in the Sharp/van der Heijde score of ≥5 units. Patients were placed in the appropriate matrix categories, with a corresponding predicted risk of RRP. The mean predicted probability for cases and noncases, integrated discrimination improvement, Hosmer-Lemeshow statistics, and C statistics were calculated.
The median age was 59 years (interquartile range [IQR] 50–66 years), the median disease duration was 12 years (IQR 4–23 years), the median swollen joint count was 6 (IQR 2–13), 84% were women, and 86% had erosions at baseline. Twelve percent of patients (32 of 271) treated with synthetic disease-modifying antirheumatic drugs (DMARDs) at baseline and 10% of patients (21 of 207) treated with biologic DMARDs experienced RRP. Most of the predictor variables had a skewed distribution in the population. All models had a suboptimal performance when applied to this cohort, with C statistics of 0.59 (model A), 0.65 (model B), and 0.57 (model C), and Hosmer-Lemeshow chi-square P values of 0.06 (model A), 0.005 (model B), and 0.05 (model C).
Matrix risk models developed in clinical trials of patients with early RA had limited ability to predict RRP in this observational cohort of RA patients.