New Help for RA Patients

Predictive models for rheumatoid arthritis (RA) appear to be promising, per recent  data published in Seminars in Arthritis and Rheumatism.


“Although the management and prognosis of RA has improved in recent decades, identification of RA patients at high risk of adverse health outcomes remains a major challenge,” Cynthia Yang, MD, of Erasmus University Medical Center, in Rotterdam, the Netherlands, and co-authors wrote. The report indicated that The European Alliance of Associations for Rheumatology (EULAR) and the American College of Rheumatology (ACR) recommend initiating methotrexate (MTX) monotherapy (with glucocorticoids) as soon as after the diagnosis of RA as possible.

Algorithmic models to predict outcomes in RA, including regarding infection and stroke, showed compelling performance.


“MTX treatment implies screening or monitoring efficacy and side-effects, as with most disease modifying antirheumatic drugs (DMARDs),” the authors indicated. “Using prediction models to evaluate patient-level risks in RA patients initiating first-line MTX monotherapy could allow clinicians to target those at high risk of adverse health outcomes for increased screening or monitoring throughout the course of treatment.”


Dr. Yang and colleagues analyzed 15 large-scale claims and health record databases across nine countries and four continents, using the Patient-Level Prediction Framework from the Observational Health Data Sciences and Informatics initiative. Researchers utilized data from one database for development, and data from the 14 databases for external validation.


The providers targeted outcomes for which patients with RA were at an increased risk, as well as outcomes that can be surveilled through the course of treatment. The first instance of several events, including leukopenia, pancytopenia and infection, occurring up to ninety (90) days after onset. Additionally, myocardial infarction and stroke events through two (2) years were included, as well as cancer through five (5) years. Patients with instances of these complications within ninety (90) days before beginning therapy were excluded.


In all, the study included 21,547 patients with RA, with 131,928 external patients contributing to validation. 


Yang and colleagues noted “RA patients identified at high risk of serious infection, MI, or stroke could be targeted for increased screening or monitoring throughout the course of treatment, complementary to current screening or monitoring strategies. In this way, the models may enable clinicians to provide better personalized care to RA patients initiating first-line MTX monotherapy.”