Abstract
Our objective was to identify distinct trajectories of disease activity state (DAS) and assess variation in radiographic progression, function and quality of life over the first two years of early rheumatoid arthritis (ERA). The CATCH (Canadian early ArThritis CoHort) is a prospective study recruiting ERA patients from academic and community rheumatology clinics in Canada. Sequential DAS28 scores were used to identify five mutually exclusive groups in the cohort (n = 1,586) using growth-based trajectory modeling. Distinguishing baseline sociodemographic and disease variables, treatment required, and differences in radiographic progression and quality of life measures over two years were assessed. The trajectory groups are characterized as: Group 1 (20%) initial high DAS improving rapidly to remission (REM); Group 2 (21%) initial moderate DAS improving rapidly to REM; Group 3 (30%) initial moderate DAS improving gradually to low DAS; Group 4 (19%) initial high DAS improving continuously to low DAS; and Group 5 (10%) initial high DAS improving gradually only to moderate DAS. Groups differed significantly in age, sex, race, education, employment, income and presence of comorbidities. Group 5 had persistent steroid requirements and the highest biologic therapy use. Group 2 had lower odds (OR 0.22, 95%CI 0.09 to 0.58) and Group 4 higher odds (OR 1.94, 95%CI 0.90 to 4.20) of radiographic progression compared to Group 1. Group 1 had the best improvement in physical function (Health Assessment Questionnaire 1.08 (SD 0.68) units), Physical Component Score (16.4 (SD 10.2) units), Mental Component Score (9.7 (SD 12.5) units) and fatigue (4.1 (SD 3.3) units). In conclusion, distinct disease activity state trajectories explain variable outcomes in ERA. Early prediction of disease course to tailor therapy and addressing social determinants of health could optimize outcomes.
Highlights
High variability has been noted within and between individuals with early rheumatoid arthritis (ERA), in their initial presentation, and in the clinical progression of their disease [1]
Our objectives were to i) evaluate whether patients could be clustered over time based on their disease activity; ii) identify whether group-based modifiable and non-modifiable sociodemographic and disease related factors differentiate group membership at disease onset; and iii) determine if such clinical distinctions are concordant with differences in radiographic progression, physical function and quality of life measures during the first two years of disease
Assessment of disease activity, medication received in a treat-to-target strategy, C-Reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR), are collected at all visits
Summary
High variability has been noted within and between individuals with early rheumatoid arthritis (ERA), in their initial presentation, and in the clinical progression of their disease [1]. Analogous to studies defining ‘responders’ and ‘non-responders’, this analytic strategy allows further refinement of outcome ascertainment, as homogeneous groups of patients similar to each other at baseline and over time for a given outcome can be characterized longitudinally in a dataset, with the important predictors of the various treatment courses determined. Building on this important work, we applied a group-based trajectory modelling strategy to data from the CATCH (Canadian Early Arthritis Cohort) Study. Our objectives were to i) evaluate whether patients could be clustered over time based on their disease activity; ii) identify whether group-based modifiable and non-modifiable sociodemographic and disease related factors differentiate group membership at disease onset; and iii) determine if such clinical distinctions are concordant with differences in radiographic progression, physical function and quality of life measures during the first two years of disease
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