Objectives Identification of trajectories of radiographic damage in rheumatoid arthritis (RA) by clustering patients according to the shape of their curve of Sharp-van der Heijde scores (SHSs) over time. Developing models to predict their progression cluster from baseline characteristics.
Methods Patient-level data over a 2-year period from five large randomised controlled trials on tumour necrosis factor inhibitors in RA were used. SHSs were clustered in a shape-respecting manner to identify distinct clusters of radiographic progression. Characteristics of patients within different progression clusters were compared at baseline and over time. Logistic regression models were developed to predict trajectory of radiographic progression using information at baseline.
Results In total, 1887 patients with 7738 X-rays were used for cluster analyses. We identified four distinct clusters with characteristic shapes of radiographic progression: one with a stable SHS over the whole 2-year period (C0/lowChange; 86%); one with relentless progression (C1/rise; 5.8%); one with decreasing SHS (C2/improvement; 6.9%); one going up and down (C3/bothWays; 1.4%) of the SHS. Robustness of clusters were confirmed using different clustering methods. Regression models identified disease duration, baseline C-reactive protein (CRP) and SHS and treatment status as predictors for cluster assignment.
Conclusions We were able to identify and partly characterise four different clusters of radiographic progression over time in patients with RA, most remarkably one with relentless progression and another one with amelioration of joint damage over time, suggesting the existence of distinct patterns of joint damage accrual in RA.
- rheumatoid arthritis
- tumour necrosis factor inhibitors
Data availability statement
Data are available on reasonable request. Data may be obtained from a third party and are not publicly available.
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Handling editor David S Pisetsky
Contributors HR, JSS, DA, SB designed the study. AP, FA, HR analysed the data. AP, FA, JSS, DA, HR, SB interpreted the results. AP, HR, DA, JSS, SB wrote the paper. All authors revised the manuscript and were involved in editing or quality control.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Disclaimer Abbvie, Janssen and Pfizer have not contributed to or approved, and are not in any way responsible for, the contents of this publication.
Competing interests HR, AP, FA: nothing to declare. DA reports grants from Abbvie, Amgen, Lilly, Novartis, Roche, SoBi, Sanofi, other from Abbvie, Amgen, Lilly, Merck, Novartis, Pfizer, Roche, Sandoz, outside the submitted work; JSS received grants to his institution from Abbvie, AstraZeneca, Janssen, Lilly, Merck Sharpe & Dohme, Pfizer and Roche, and provided expert advice for, or had symposia speaking engagements with, AbbVie, Amgen, AstraZeneca, Astro, Bristol-Myers Squibb, Celgene, Celltrion, Chugai, Gilead, ILTOO Pharma, Janssen, Lilly, Merck Sharp & Dohme, Novartis-Sandoz, Pfizer, Roche, Samsung, Sanofi and UCB. SB reports personal fees from Abbvie, personal fees from Novartis, outside the submitted work.
Provenance and peer review Not commissioned; externally peer reviewed.
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