Clinical Prediction Score of 1-Year Sustained Remission to Methotrexate Combination Therapy in Patients with Early Rheumatoid Arthritis

Objective: To develop a prediction stratification score for the prediction of sustained remission (SR) to methotrexate (MTX) therapy in patients with early rheumatoid arthritis (ERA). Materials and Methods: Prognostic research with clinical prediction score was conducted. All patients with ERA who experienced moderate to high disease activity at a tertiary hospital were included. Multivariable logistic regression models were used to assess each variable predictor. Logistic coefficients of each predictor were used for generating scores. Predictive performance was internally validated using bootstrapping techniques. Results: One hundred seventy-five patients, of which 93 had SR, were included. The prediction score had four final predictors, age less than 65 years (0, 2), initial health assessment questionnaires less than 1 (0, 3), baseline disease activity score in 28 joints-erythrocyte sedimentation rate (DAS28-ESR) (0, 1), and DAS28-ESR at three months less than 3.2 (0, 5) were included in the logistic model. The positive predictive value for the high-risk score, which was greater than 3.5, was 87 (95% CI 76.7 to 93.9) results used in the model as a clinical predictor of MTX response. The SR score had a good predictive performance (AUROC 0.85, 95% CI 0.80 to 0.90). Conclusion: The SR score demonstrated good performance and discrimination for predicting SR to MTX combination therapy in patients with ERA for a safe long term follow up using simplified parameters in a clinical setting.