Prediction of radiological outcome in early rheumatoid arthritis in clinical practice: role of antibodies to citrullinated peptides (anti-CCP)

Abstract

Objective: To investigate the role of anti-cyclic citrullinated peptide antibody (anti-CCP) for the prediction of radiological outcome in patients with early rheumatoid arthritis. Methods: Anti-CCP was assessed at baseline in 379 patients with early rheumatoid arthritis (disease duration ,1 year). Radiological joint damage and progression were assessed by Larsen score after two years of follow up (end point) and used as outcome variables. The prognostic value of anti-CCP and other demographic and disease related baseline variables were assessed by univariate and multivariate analyses, including calculation of odds ratios (OR), predictive values, and multiple logistic regression models.Results: The presence of anti-CCP was associated with significantly higher Larsen score both at baseline and at end point. Univariate predictor analysis showed that anti-CCP had the highest significant OR for radiological joint damage and progression after baseline Larsen score, followed by rheumatoid factor, erythrocyte sedimentation rate (ESR), C reactive protein, age, smoking status, and sex. In stepwise multiple regression analyses, baseline Larsen score, anti-CCP, and ESR were selected as significant independent predictors of the radiological outcomes. Conclusions: There is good evidence for an association of anti-CCP with radiological joint changes in rheumatoid arthritis. Anti-CCP is an independent predictor of radiological damage and progression. Though prediction in early rheumatoid arthritis is still far from perfect, the use of anti-CCP in clinical practice should make it easier for rheumatologists to reach judicious treatment decisions.

Antibodies to citrullinated α‐enolase peptide 1 are specific for rheumatoid arthritis and cross‐react with bacterial enolase

“…Kuhn et al, for example, recently demonstrated that administration of anti-citrullinated fibrinogen antibodies enhanced disease severity in an experimental mouse model of arthritis (4). In the majority of patients with RA, the presence of ACPAs antedates disease onset (5,6), and ACPA-positive patients present with a more severe and erosive form of arthritis (7)(8)(9)(10)(11)(12)(13)(14)(15)(16). A commercial enzyme-linked immunosorbent assay (ELISA) based on cyclic citrullinated peptides (CCPs) detects ACPAs and is now routinely used in the diagnosis of RA.…”

The presence of rheumatoid nodules at early rheumatoid arthritis diagnosis is a sign of extra-articular disease and predicts radiographic progression of joint destruction over 5 years

“…Several studies have shown that radiological outcome can be predicted by the presence of RF [19,20] and antibodies against cyclic citrullinated peptides (anti-CCP) [21][22][23] at the time of diagnosis of early RA, and the level of anti-CCP seems to be of importance [24]. In an inception cohort of patients with newly presenting inflammatory poly-arthritis [19], inflammatory activity [joint counts and C-reactive protein (CRP)] and immune pathology (RF and RN) predicted the severity of erosions early in the disease.…”

A Molecular Analysis of the Shared Epitope Hypothesis: Binding of Arthritogenic Peptides to DRB1*04 Alleles

“…We measured binding of native and citrullinated forms of vimentin [66][67][68][69][70][71][72][73][74][75][76][77][78] and a-enolase [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] and noncitrullinated type II collagen [258][259][260][261][262][263][264][265][266][267][268][269][270][271][272] to 88 class II alleles on Luminex beads (which includes alleles of many varying degrees of susceptibility and resistance). We expressed DRB1*04:01, *04:02, and *08:01 in T2 cells and mutated DRB1*04:01 at positions 67, 70, 71, 74, and 86 to corresponding residues in DRB1*04:02, *04:03, *04:04, *04:05, and *08:01.…”