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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
  1. K Visser1,
  2. Y P M Goekoop-Ruiterman2,
  3. J K de Vries-Bouwstra3,
  4. H K Ronday2,
  5. P E H Seys4,
  6. P J S M Kerstens5,
  7. T W J Huizinga1,
  8. B A C Dijkmans3,
  9. C F Allaart1
  1. 1Leiden University Medical Center, Leiden, The Netherlands
  2. 2HAGA Hospital, The Hague, The Netherlands
  3. 3VUMC, Amsterdam, The Netherlands
  4. 4Franciscus Hospital, Roosendaal, The Netherlands
  5. 5JBI, Amsterdam, The Netherlands
  1. Correspondence to Dr K Visser, Department of Rheumatology C1-R, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; k.visser{at}


Objectives To develop a matrix model for the prediction of rapid radiographic progression (RRP) in subpopulations of patients with recent-onset rheumatoid arthritis (RA) receiving different dynamic treatment strategies.

Methods Data from 465 patients with recent-onset RA randomised to receive initial monotherapy or combination therapy were used. Predictors for RRP (increase in Sharp-van der Heijde score ≥5 after 1 year) were identified by multivariate logistic regression analysis. For subpopulations, the estimated risk of RRP per treatment group and the number needed to treat (NNT) were visualised in a matrix.

Results The presence of autoantibodies, baseline C-reactive protein (CRP) level, erosion score and treatment group were significant independent predictors of RRP in the matrix. Combination therapy was associated with a markedly reduced risk of RRP. The positive and negative predictive values of the matrix were 62% and 91%, respectively. The NNT with initial combination therapy to prevent one patient from RRP with monotherapy was in the range 2–3, 3–7 and 7–25 for patients with a high, intermediate and low predicted risk, respectively.

Conclusion The matrix model visualises the risk of RRP for subpopulations of patients with recent-onset RA if treated dynamically with initial monotherapy or combination therapy. Rheumatologists might use the matrix for weighing their initial treatment choice.

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  • Funding The BeSt study was supported by the Dutch College of Health Insurances. Schering-Plough and Centocor provided additional funding.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Leiden University Medical Center ethics committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.