Radiological outcome in rheumatoid arthritis is predicted by the presence of antibodies against cyclic citrullinated peptide before and at disease onset, and by IgA-rheumatoid factor at disease onset

• Published in: Annals of the Rheumatic Diseases
• Main Authors: Berglin, Ewa, Johansson, Thord, Sundin, Ulf, Jidell, Erik, Wadell, Göran, Hallmans, Göran, Rantapåå-Dahlqvist, Solbritt
• Format: Text
• Language: English
• Published: BMJ Publishing Group Ltd 2005
• Subjects: Extended Report; Northern Sweden
• Online Access: http://ard.bmj.com/cgi/content/short/ard.2005.041376v1; https://doi.org/10.1136/ard.2005.041376

Objective: To evaluate the significance of antibodies against cyclic citrullinated peptide (anti- CCP) and rheumatoid factors (RFs), in individuals before onset of rheumatoid arthritis (RA) and when presenting as early RA (baseline), for disease activity and progression. Methods: Ninety-three of a cohort of 138 patients with early RA (i.e., <12 months of symptoms) had donated blood before symptoms of RA (defined as pre- patients) and were identified from among blood donors within the Medical Biobank of northern Sweden. Disease activity (ESR, CRP, joint score, global VAS) and radiological destruction in hands and feet (Larsen score) were assessed at baseline and after 2 years. Anti- CCP antibodies and RFs were analysed using enzyme immunoassays. HLA shared epitope (SE) alleles (DRB1*0401/0404) were identified. Results: Patients with anti-CCP antibodies before disease onset had significantly higher Larsen score at baseline and after 2 years. In multiple regression analyses baseline values of anti-CCP/IgA-RF/IgG-RF/IgM- RF, swollen joint count and Larsen score significantly predicted radiological outcome at 2 years. In logistic regression analyses baseline values of anti-CCP antibodies/IgA-RF, and therapeutic response at 6 months and, swollen joint count/ESR, respectively, and significantly predicted radiological progression after 2 years. The baseline titre of anti-CCP antibodies was higher in patients with radiological progression and decreased significantly in patients with response to therapy. SE allele carriage was significantly associated with a positive test for anti-CCP antibodies in pre-patients and in early RA patients. Conclusion: Presence of anti-CCP antibodies before disease onset is associated with more severe radiological damage. The titre of anti-CCP antibodies is related to disease severity.