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Objective  Progressive rheumatoid arthritis ( RA ) is responsible for joint damage causing disabilities, but there is no agreement on which disease measures best predict radiographic progression. We aimed to determine which disease activity measures, including the disease activity score, the modified disease activity score in 28 joints with C‐reactive protein testing (M‐ DAS 28‐ CRP ), the Clinical Disease Activity Index, and the Health Assessment Questionnaire Disability Index, at baseline and 3 months best predicted rapid radiographic progression ( RRP ) in patients with early  RA .    Methods  Data were used from  PREMIER , a 2‐year, multicenter, double‐blind, active comparator controlled study with methotrexate ( MTX )–naïve patients with  RA  and active disease for less than 3 years. Treatments included adalimumab plus oral  MTX , adalimumab, or oral  MTX . Only patients in the  MTX  arm were analyzed in this study.  RRP  was defined as a change in the modified total Sharp score of less than 3.5 at month 12. The logistic regression analysis assessed the impact of measures at baseline and 3 months on  RRP  at 12 months. Best cutoff points of the M‐ DAS 28‐ CRP  were also estimated by using area under the receiver operating characteristic curve.    Results  A total of 149 patients were included (female patients: n = 113 [75.8%]; positive rheumatoid factor: n = 127 [85.2%]; mean [ SD ] age: 52.9 [13.3] years; mean [ SD ] disease duration: 0.8 [0.9] year; mean [ SD ] M‐ DAS 28‐ CRP : 6.3 [0.9]). After adjusting for potential confounders, only the M‐ DAS 28‐ CRP  at baseline (adjusted odds ratio [ AOR ] = 3.29; 95% confidence interval [ CI ]: 1.70‐6.36) and 3 months ( AOR  = 2.56; 95%  CI : 1.43‐4.56) strongly predicted  RRP  at 12 months. M‐ DAS 28‐ CRP  of 4.5 and 2.6 at baseline and 3 months, respectively, maximized positive and negative predictive values for prediction of  RRP .    Conclusion  The M‐ DAS 28‐ CRP  was a stronger predictor at baseline and 3 months for  RRP  compared with other disease activity measures. Removing tender joint count and patient global assessment from the  DAS 28‐ CRP  improves prediction of  RRP .

acr open rheumatology

Modified Disease Activity Score at 3 Months Is a Significant Predictor for Rapid Radiographic Progression at 12 Months Compared With Other Measures in Patients With Rheumatoid Arthritis