Current smoking status is a strong predictor of radiographic progression in early rheumatoid arthritis: results from the SWEFOT trial

Saedis Saevarsdottir, Hamed Rezaei, Pierre Geborek, Ingemar Petersson, Sofia Ernestam, Kristina Albertsson, Kristina Forslind, Ronald F van Vollenhoven, SWEFOT study group, Saedis Saevarsdottir, Hamed Rezaei, Pierre Geborek, Ingemar Petersson, Sofia Ernestam, Kristina Albertsson, Kristina Forslind, Ronald F van Vollenhoven, SWEFOT study group

Abstract

Objectives: To study clinical predictors for radiographic progression after 1 year in an early rheumatoid arthritis (RA) trial.

Methods: In the SWEFOT trial population, disease modifying antirheumatic drug (DMARD) naïve RA patients started methotrexate; 3-month responders (DAS28 <3.2) continued (n=147), while non-responders were randomised to addition of sulfasalazine+hydroxychloroquine (n=130) or infliximab (n=128). X-rays were scored by the Sharp-van der Hejde score (SHS) method and radiographic progression was defined as a ≥5 increase after 1 year. Potential baseline predictors of radiographic progression were tested using multivariable logistic regression, adjusted for potential confounders.

Results: 79 of 311 patients with available radiographs at baseline and follow-up had radiographic progression. The following baseline parameters were independent predictors of radiographic progression at 1 year: baseline erosions (adjusted OR=2.29, 95% CI 1.24 to 4.24), erythrocyte sedimentation rate (adjusted OR per tertile increase=1.72, 95% CI 1.12 to 2.65) and C-reactive protein (adjusted OR per tertile increase=1.52, 95% CI 1.03 to 2.26). Current smoking was an independent predictor of radiographic progression (adjusted OR=2.17, 95% CI 1.06 to 4.45). These results remained after further adjustment for treatment strategy. Three-dimensional matrix including current smoking status, erosions and C-reactive protein tertiles showed a 12-63% risk gradient from patients carrying none compared with all predictors. Rheumatoid factor (RF)/anti-cyclic citrullinated peptide (anti-CCP) positivity did not significantly predict radiographic progression using SHS increase ≥5 as cut-off. In a secondary exploratory analysis using cut-off >1, both RF and anti-CCP positivity were significant predictors in the unadjusted, but not the adjusted analyses. The other parameters also remained significant using this lower cut-off.

Conclusions: In addition to previously described predictors, we identified smoking as a strong independent risk factor for radiographic progression in early RA.

Trial registration number: NCT00764725.

Keywords: Early Rheumatoid Arthritis; Outcomes research; Smoking.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Figures

Figure 1
Figure 1
Risk matrices showing the proportion of SWEFOT patients who have developed radiographic progression (% and number with increase in Sharp–van der Hejde score ≥5 divided by total number in group) after 1 year, sub-grouped by baseline parameters identified using multivariable logistic regression analysis in the whole group and stratified by anti-cyclic citrullinated peptide (anti-CCP) status. Finally, we tested a previously reported matrix by Visser et al. CRP, C-reactive protein; RF, rheumatoid factor; RRP, rapid radiographic progression.
Figure 2
Figure 2
Risk matrices showing the proportion of SWEFOT patients who have developed radiographic progression (% and number with increase in Sharp–van der Hejde score ≥5 divided by total number in group) after 1 year in all early rheumatoid arthritis patients and stratified by treatment month 3–12. CRP, C-reactive protein; RRP, rapid radiographic progression.
Figure 3
Figure 3
Risk matrices showing the proportion of SWEFOT patients who have developed radiographic progression (% and number with increase in Sharp–van der Hejde score ≥5 divided by total number in group) after 1 year in all early rheumatoid arthritis patients and stratified by sex. CRP, C-reactive protein; RRP, rapid radiographic progression.

References

    1. van Nies JA, Krabben A, Schoones JW, et al. What is the evidence for the presence of a therapeutic window of opportunity in rheumatoid arthritis? A systematic literature review. Ann Rheum Dis 2014;73:861–70.
    1. Rezaei H, Saevarsdottir S, Forslind K, et al. In early rheumatoid arthritis, patients with a good initial response to methotrexate have excellent 2-year clinical outcomes, but radiological progression is not fully prevented: data from the methotrexate responders population in the SWEFOT trial. Ann Rheum Dis 2012;71:186–91.
    1. Clarke AE, St-Pierre Y, Joseph L, et al. Radiographic damage in rheumatoid arthritis correlates with functional disability but not direct medical costs. J Rheumatol 2001;28:2416–24.
    1. Welsing PM, van Gestel AM, Swinkels HL, et al. The relationship between disease activity, joint destruction, and functional capacity over the course of rheumatoid arthritis. Arthritis Rheum 2001;44:2009–17.
    1. Visser K, Goekoop-Ruiterman YP, de Vries-Bouwstra JK, et al. A matrix risk model for the prediction of rapid radiographic progression in patients with rheumatoid arthritis receiving different dynamic treatment strategies: post hoc analyses from the BeSt study. Ann Rheum Dis 2010;69:1333–7.
    1. Vastesaeger N, Xu S, Aletaha D, et al. A pilot risk model for the prediction of rapid radiographic progression in rheumatoid arthritis. Rheumatology (Oxford) 2009;48:1114–21.
    1. Fautrel B, Granger B, Combe B, et al. Matrix to predict rapid radiographic progression of early rheumatoid arthritis patients from the community treated with methotrexate or leflunomide: results from the ESPOIR cohort. Arthritis Res Ther 2012;14:R249.
    1. Durnez A, Vanderschueren G, Lateur L, et al. Effectiveness of initial treatment allocation based on expert opinion for prevention of rapid radiographic progression in daily practice of an early RA cohort. Ann Rheum Dis 2011;70:634–7.
    1. Lillegraven S, Paynter N, Prince FH, et al. Performance of matrix-based risk models for rapid radiographic progression in a cohort of patients with established rheumatoid arthritis. Arthritis Care Res (Hoboken) 2013;65:526–33.
    1. Nyhall-Wahlin BM, Petersson IF, Nilsson JA, et al. High disease activity disability burden and smoking predict severe extra-articular manifestations in early rheumatoid arthritis. Rheumatology (Oxford) 2009;48:416–20.
    1. Wolfe F. The effect of smoking on clinical, laboratory, and radiographic status in rheumatoid arthritis. J Rheumatol 2000;27:630–7.
    1. Harrison BJ, Silman AJ, Wiles NJ, et al. The association of cigarette smoking with disease outcome in patients with early inflammatory polyarthritis. Arthritis Rheum 2001;44:323–30.
    1. Papadopoulos NG, Alamanos Y, Voulgari PV, et al. Does cigarette smoking influence disease expression, activity and severity in early rheumatoid arthritis patients? Clin Exp Rheumatol 2005;23:861–6.
    1. Saevarsdottir S, Wedren S, Seddighzadeh M, et al. Patients with early rheumatoid arthritis who smoke are less likely to respond to treatment with methotrexate and tumor necrosis factor inhibitors: observations from the Epidemiological Investigation of Rheumatoid Arthritis and the Swedish Rheumatology Register cohorts. Arthritis Rheum 2011;63:26–36.
    1. Saevarsdottir S, Wallin H, Seddighzadeh M, et al. Predictors of response to methotrexate in early DMARD naive rheumatoid arthritis: results from the initial open-label phase of the SWEFOT trial. Ann Rheum Dis 2011;70:469–75.
    1. van Vollenhoven RF, Ernestam S, Geborek P, et al. Addition of infliximab compared with addition of sulfasalazine and hydroxychloroquine to methotrexate in patients with early rheumatoid arthritis (Swefot trial): 1-year results of a randomised trial. Lancet 2009;374:459–66.
    1. van Vollenhoven RF, Geborek P, Forslind K, et al. Conventional combination treatment versus biological treatment in methotrexate-refractory early rheumatoid arthritis: 2 year follow-up of the randomised, non-blinded, parallel-group Swefot trial. Lancet 2012;379:1712–20.
    1. Bruynesteyn K, van der Heijde D, Boers M, et al. Determination of the minimal clinically important difference in rheumatoid arthritis joint damage of the Sharp/van der Heijde and Larsen/Scott scoring methods by clinical experts and comparison with the smallest detectable difference. Arthritis Rheum 2002;46:913–20.
    1. de Rooy DPC, van Nies JAB, Kapetanovic MC, et al. Smoking as a risk factor for the radiological severity of rheumatoid arthritis: a study on six cohorts. Ann Rheum Dis 2014;73:1384–7.

Source: PubMed

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