Brigham and Women's Hospital, Boston, Massachusetts; Diakonhjemmet Hospital, Oslo, Norway.
Arthritis Care Res (Hoboken). 2013 Apr;65(4):526-33. doi: 10.1002/acr.21870.
Matrix-based risk models have been proposed as a tool to predict rapid radiographic progression (RRP) in rheumatoid arthritis (RA), but the experience with such models is limited. We tested the performance of 3 risk models for RRP in an observational cohort.
Subjects from an observational RA cohort with hand radiographs and necessary predictor variables to be classified by the risk models were identified (n = 478). RRP was defined as a yearly change in the Sharp/van der Heijde score of ≥5 units. Patients were placed in the appropriate matrix categories, with a corresponding predicted risk of RRP. The mean predicted probability for cases and noncases, integrated discrimination improvement, Hosmer-Lemeshow statistics, and C statistics were calculated.
The median age was 59 years (interquartile range [IQR] 50-66 years), the median disease duration was 12 years (IQR 4-23 years), the median swollen joint count was 6 (IQR 2-13), 84% were women, and 86% had erosions at baseline. Twelve percent of patients (32 of 271) treated with synthetic disease-modifying antirheumatic drugs (DMARDs) at baseline and 10% of patients (21 of 207) treated with biologic DMARDs experienced RRP. Most of the predictor variables had a skewed distribution in the population. All models had a suboptimal performance when applied to this cohort, with C statistics of 0.59 (model A), 0.65 (model B), and 0.57 (model C), and Hosmer-Lemeshow chi-square P values of 0.06 (model A), 0.005 (model B), and 0.05 (model C).
Matrix risk models developed in clinical trials of patients with early RA had limited ability to predict RRP in this observational cohort of RA patients.
基质为基础的风险模型已被提出作为一种工具来预测类风湿关节炎（RA）的快速放射进展（RRP），但此类模型的经验有限。我们在一个观察性队列中测试了 3 种 RRP 风险模型的性能。
从具有手部射线照片和必要预测变量的观察性 RA 队列中确定了符合风险模型分类的患者（n = 478）。RRP 定义为Sharp/van der Heijde 评分每年变化≥5 个单位。将患者归入适当的基质类别，相应的 RRP 预测风险。计算病例和非病例的平均预测概率、综合判别改善、Hosmer-Lemeshow 统计量和 C 统计量。
中位年龄为 59 岁（四分位间距 [IQR] 50-66 岁），中位病程为 12 年（IQR 4-23 年），中位肿胀关节计数为 6（IQR 2-13），84%为女性，86%基线时有侵蚀。基线时接受合成改善病情抗风湿药物（DMARDs）治疗的患者中 12%（271 例中的 32 例）和接受生物 DMARDs 治疗的患者中 10%（207 例中的 21 例）发生 RRP。大多数预测变量在人群中呈偏态分布。当应用于该队列时，所有模型的性能均不理想，C 统计量分别为 0.59（模型 A）、0.65（模型 B）和 0.57（模型 C），Hosmer-Lemeshow chi-square P 值分别为 0.06（模型 A）、0.005（模型 B）和 0.05（模型 C）。
在早期 RA 临床试验中开发的基质风险模型在这个观察性 RA 患者队列中预测 RRP 的能力有限。
