Please use this identifier to cite or link to this item:
http://hdl.handle.net/1942/2614
Title: | Association of baseline levels of markers of bone and cartilage degradation with long-term progression of joint damage in patients with early rheumatoid arthritis - The COBRA Study | Authors: | Garnero, P Landewe, R Boers, M Verhoeven, A van der Linden, S Christgau, S Boonen, A VAN DER HEIJDE, Desiree GEUSENS, Piet |
Issue Date: | 2002 | Publisher: | WILEY-LISS | Source: | ARTHRITIS AND RHEUMATISM, 46(11). p. 2847-2856 | Abstract: | Objective. The known risk factors for radiologic progression in rheumatoid arthritis (RA) are not optimally discriminative in patients with early disease who do not have evidence of radiologic damage. We sought to determine whether urinary C-terminal crosslinking telopeptide of type I (CTX-I) and type II (CTX-II) collagen (markers of bone and cartilage destruction, respectively) are associated with long-term radiologic progression in patients with early RA. Methods. This was a prospective study of 110 patients with early RA who were participating in the COBRA (Combinatietherapie Bij Reumatoide Artritis) clinical trial and followup study, a randomized controlled trial comparing the efficacy of oral pulse prednisolone, methotrexate, plus sulfasalazine with sulfasalazine alone. We investigated the relationship between baseline levels of urinary CTX-I and CTX-II and the mean annual progression of joint destruction over a median of 4 years, as measured by changes in the modified Sharp score (average of 2 independent readers). Results. In multivariate logistic regression analysis, baseline urinary CTX-I and CTX-II levels in the highest tertile were the strongest predictors of radiologic progression (Sharp score increase >2 units/year; odds ratio 7.9 and 11.2, respectively), independently of treatment group, erythrocyte sedimentation rate (ESR), Disease Activity Score in 28 joints, rheumatoid factor (RF), and baseline joint damage (Sharp score). The likelihood ratios for a positive test were 3.8 and 8.0 for CTX-I and CTX-II, respectively, which compared favorably with the likelihood ratios for the ESR (3.0), baseline joint damage (1.6), and RF (1.8). When patients were grouped according to the presence (Sharp score greater than or equal to4, n = 49) and absence (Sharp score <4, n = 61) of joint damage at baseline, CTX-I and CTX-II levels were predictive only in those without baseline joint damage (odds ratio 14.9 and 25.7, respectively). Conclusion. High baseline levels of urinary CTX-I and CTX-II independently predict an increased risk of radiologic progression over 4 years in patients with early RA, especially those without radiologic joint damage. Urinary CTX-I and CTX-II may be useful for identifying individual RA patients at high risk of progression very early in the disease, before erosions can be detected radiographically. Such patients may be in special need of treatments that inhibit bone and cartilage degradation. | Notes: | INSERM, Res Unit 403, Lyon, France. Synarc, Lyon, France. Univ Hosp Maastricht, Maastricht, Netherlands. Univ Amsterdam, Med Ctr, NL-1105 AZ Amsterdam, Netherlands. Nord Biosci, Herlev, Denmark. Limburgs Univ Ctr, Biomed Res Inst, Diepenbeek, Belgium.Garnero, P, Hop Edouard Herriot, INSERM, Res Unit 403, Pavillon F, F-69437 Lyon 03, France. | Document URI: | http://hdl.handle.net/1942/2614 | ISSN: | 0004-3591 | DOI: | 10.1002/art.10616 | ISI #: | 000179239500004 | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2003 |
Appears in Collections: | Research publications |
Show full item record
SCOPUSTM
Citations
165
checked on Sep 5, 2020
WEB OF SCIENCETM
Citations
159
checked on Oct 14, 2024
Page view(s)
54
checked on Nov 7, 2023
Google ScholarTM
Check
Altmetric
Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.