Distinct Symptom Clusters Predict Initial Response to MTX in Adults with New RA: A Longitudinal Analysis of the Canadian Early Arthritis Cohort
Notice bibliographique
Résumé
Objectives Symptom clusters, the co-occurrence of 2+ symptoms that are stable and independent of other clusters, may share underlying mechanisms and lead to different disease outcomes, particularly if symptoms are under identified and undertreated. If patients with distinct symptom clusters display unique patterns of treatment response, this can help better match patients to treatments to optimize disease control and QOL. We previously applied a person-centered approach to group newly diagnosed early RA patients based on patient-reported pain, fatigue, depression, and anxiety levels. We compared outcomes of initial 6-month MTX response across new-onset RA patients by symptom clusters. Methods Data were from new RA patients (symptoms < 1 year) in the Canadian Early Arthritis Cohort (CATCH) between Jan 2017-Aug 2022 with active disease who were starting MTX. Participants underwent standardized assessments and completed PROMIS29 at 0, 3, and 6 months. Latent Class Analysis yielded 4 distinct groups: 1. Minimal Symptoms; 2. Mild symptoms; 3. Moderate symptoms; and 4. Moderate-Severe symptoms. Multivariable mixed effects regression was used to estimate trajectories of CDAI, disability, and participation over the first 6 months of MTX treatment across cluster groups updated at each time point and adjusting for age, sex, race, education, smoking, obesity, comorbidities, symptom duration, seropositivity, and RA treatments. Results At diagnosis, 310 ERA adults had a mean (SD) age of 56 (14), and were mostly female (67%), White (78%) with a CDAI of 29.3 (13.2). All started MTX, with no significant difference in dose or strategy across cluster groups. All groups had high disease activity (CDAI) scores at enrollment, though patients reporting severe pain, fatigue, depression, and anxiety symptoms were significantly younger, more often had a history of depression, had the highest mean CDAI, Patient Global and stiffness scores, and greater impairments in function and participation than other groups. In adjusted regression models, all groups improved over 6 months but patients in severe symptom categories consistently displayed worse trajectories of disease activity, function, and participation over the 6-month follow-up period (Figure). Predicted trajectories of CDAI, Physical Function and Social Function by symptom clusters over first 6 months Conclusion Beyond disease activity at RA onset, evaluating the presence of specific symptom clusters in the first 6 months of new RA could better identify individuals at risk for poorer MTX response. These individuals may benefit from earlier, more aggressive pharmacologic and psychosocial interventions. Addressing both physical and emotional symptoms may improve physical and social function in early RA helping to preserve autonomy, workforce participation, and QOL.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».