The adjusted multi-biomarker disease activity (MBDA) score can be used to predict radiographic progression in patients with rheumatoid arthritis (RA), according to study results published in Arthritis Research & Therapy.

Tools to assess RA disease activity and to predict structural deterioration are important, the study researchers underscored. The MBDA score is based on 12 serum biomarkers, including C-reactive protein (CRP),  and can be used to determine disease activity in adults with RA. Changes in MBDA score correlate with changes in clinical disease activity. A modified MBDA score includes an adjustment for the effects of age, sex, and adiposity and was previously validated in 2 cohorts (OPERA and BRASS) of patients with RA.

As limited data exist on the prognostic accuracy of the adjusted MBDA score, the objective of the current study was to validate the score as a prognostic test for radiographic progression in 2 additional cohorts, to compare it with other measures in 4 cohorts, and to generate curves for predicting risk for radiographic progression.

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Researchers defined the radiographic progression as a rate of change in total Sharp Score (TSS) >5 U/y.

They used patient-level data on 953 patients receiving nonbiologic and biologic disease-modifying antirheumatic drugs collected from 4 cohorts (OPERA, SWEFOT, Leiden, and BRASS) and determined the association of radiographic progression per year with the adjusted MBDA score, seropositivity, and clinical measures.

The data suggest that the adjusted MBDA score was the strongest single, independent predictor of radiographic progression compared with seropositivity for rheumatoid factor and/or anticyclic citrullinated peptide antibodies. The investigators found that the adjusted MBDA score was a more statistically significant predictor of radiographic progression than baseline TSS, and various RA disease activity measures, including disease activity score with 28 joints using CRP (DAS28-CRP), CRP, swollen joint count, or clinical disease activity index.

When there was a discordant between the adjusted MBDA score and RA disease activity measures, the frequency of radiographic progression corresponded more consistently with the adjusted MBDA than all of the RA disease activity measures assessed, it was noted.

Radiographic progression was rare when the adjusted MBDA score was low, and the frequency of radiographic progression was highest (13.2%-16.8%) when the adjusted MBDA score was high, regardless of the DAS28-CRP.

A risk curve indicated the risk for radiographic progression was minimal when the adjusted MBDA score was low, and the risk increased continuously with the adjusted MBDA score. Among the highest adjusted MBDA scores, the risk exceeded 40%, and when the adjusted MBDA score was very high, that risk exceeded 50%.

The study limitations included the determination of radiographic progression by different readers in each cohort and missing data on patient global assessment and smoking habits. In addition, tumor necrosis factor inhibitors were the only biologic agents included in the 4 cohorts.

“The results of this study validate the adjusted MBDA score as an objective, independent measure of disease activity that, without requiring information from clinical assessment, can stratify RA patients according to their risk for developing new joint damage,” concluded the researchers.

Disclosure: This clinical trial was supported by Myriad Genetics. Please see the original reference for a full list of authors’ disclosures.


Curtis JR, Weinblatt ME, Shadick NA, et al. Validation of the adjusted multi-biomarker disease activity score as a prognostic test for radiographic progression in rheumatoid arthritis: a combined analysis of multiple studies. Arthritis Res Ther. 2021;23(1):1. Doi: 10.1186/s13075-020-02389-4