Time-independent disease state identification defines distinct trajectories determined by localised vs systemic inflammation in patients with early rheumatoid arthritis
Authors' conclusion
We identified 4 distinct trajectories in early RA, differentiating RA into localised vs systemic inflammation.
Study context
- Population
- Patients with early rheumatoid arthritis (RA) followed over 1.5 years, Netherlands and UK
- Participants
- 1,237 vs 243
- Exposure
- Leiden vs Towards a Cure for Early Rheumatoid Arthritis (TACERA)
- Leidenn = 1,237
- TACERAn = 243
- Outcome
- Disease states and trajectories identified by time-independent clustering of clinical and haematologic features
- Follow-up
- 1.5 years
Methodological detailsgraph-based pseudotime analysis, time-independent clustering, external replication cohort
- Graph-based pseudotime analysis
- Time-independent clustering
- External replication cohort
Main finding
As reported in the abstract
Disease states identified, with localised (joints) and systemic (ESR or leucocytes) inflammation as main discriminating factors
8
Trajectories (A, high ESR; B, rapid progression from many inflamed joints to remission; C, high leucocytes; D, many inflamed joints with poor prognosis), independently replicated in TACERA
4
Observational data: associations, not effects.
Further findings
Prediction of trajectories at baseline by systemic vs local inflammation patterns
- Sensitivity, trajectory A
- 71%
- Precision, trajectory A
- 0.73
- Precision, trajectory B
- 0.52
- Other trajectories less predictable
- Moderate predictability
Trajectory characteristics
- Trajectories C and D resembled B at baseline but deteriorated into less favourable trajectories
- Patients in trajectory A more often female and on average older
- Trajectories not explained by time till DMARD, baseline disease activity or symptom duration
- Suboptimal trajectories coincided with worse patient-reported outcomes, even when inflammation mainly systemic
Original publication
Time-independent disease state identification defines distinct trajectories determined by localised vs systemic inflammation in patients with early rheumatoid arthritis. Ann Rheum Dis. Published 9 May 2025. doi:10.
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