The performance of anti–cyclic citrullinated peptide antibodies in predicting the severity of radiologic damage in inflammatory polyarthritis: Results from the Norfolk Arthritis Register

Abstract

ObjectiveAnti–cyclic citrullinated peptide (anti-CCP) antibodies are a stronger predictor of the severity of rheumatoid arthritis than is rheumatoid factor (RF). Their role in predicting outcome in unselected patients with new-onset inflammatory polyarthritis (IP) has not been examined. The aims of this study were to examine the role of baseline RF and anti-CCP antibodies in determining the likelihood of patients having erosions at presentation or in predicting future radiologic damage, and to determine whether anti-CCP antibodies or RF is sufficiently robust to be clinically useful in guiding treatment decisions in early IP.MethodsPatients were recruited from the Norfolk Arthritis Register. Logistic regression models were fitted to test the ability of anti-CCP antibodies and RF to predict erosions. Further models were investigated to examine the role of anti-CCP antibodies in patients stratified by RF status.ResultsThe presence of anti-CCP antibodies at baseline was strongly associated with both prevalent erosions (odds ratio [OR] 2.53 [95% confidence interval (95% CI) 1.48–4.30]) and developing erosions at 5 years (OR 10.2 [95% CI 6.2–16.9]). These ORs were higher than those for RF (OR 1.63 [95% CI 0.94–2.82] and OR 3.4 [95% CI 2.2–5.2], respectively). The likelihood ratio (LR) for the prediction of prevalent erosions and erosions at 5 years was highest in the RF−subgroup (LR 2.2 and 5.8, respectively). However, 27% of anti-CCP−patients had developed erosions by 5 years.ConclusionDespite their strong association with the presence, development, and extent of erosions, anti-CCP antibodies alone are not a sufficiently accurate measure upon which to base clinical treatment decisions. Knowledge of anti-CCP antibody status is most informative in RF−negative patients.

Romatoid Artritli Hastalarda Serum Anti-Cyclic Citrullinated Peptid Antikor Düzeyleri ve Hastalık Aktivitesi Arasındaki İlişki

“…Several studies demonstrate the association of anti-CCP positivity with joint destruction in patients with established RA (15,16,17). In our study, joint erosions and deformities were not associated with anti-CCP positivity.…”

Anti-Cyclic Citrullinated Peptide Antibody versus HAQ/MDHAQ: Comparing Apples and Oranges?

“…In a recent study of 238 patients with RA (Norfolk Arthritis Register, 10-year followup), anti-CCP was the strongest independent predictor of radiographic progression. The presence of anti-CCP antibodies at baseline was a more powerful predictor of both prevalent erosions (OR 2.5) and developing erosions by 5 years (OR 10.2) than was the presence of RF (OR 1.6 and 3.4, respectively) 11 . The presence of RF did not yield significantly higher odds of erosions than anti-CCP alone.…”

“…The presence of RF did not yield significantly higher odds of erosions than anti-CCP alone. However, it was noted that in people with early inflammatory arthritis followed in this Norfolk Arthritis Register, a significant number of anti-CCP-negative patients developed erosions at 5 years (27% of the prospective cohort), whereas 21% of patients positive for presence of anti-CCP antibodies had not developed erosions at 5 years 11 . Further, the strength of the association between anti-CCP positivity and development of erosions was damped by the treatment effects of using DMARD and corticosteroids.…”

Analysis of foot structural damage in rheumatoid arthritis: clinical evaluation by validated measures and serological correlations

“…Studi che hanno valutato una possibile correlazione tra le alterazioni della struttura e della funzionalità del piede reumatoide ed alcuni parametri identificanti l'attività di malattia ed il danno funzionale da essa indotto sono piuttosto scarsi. Scopo del presente lavoro è stato pertanto quello di verificare in una coorte di pazienti affetti da AR l'esistenza di una possibile correlazione tra il tipo di danno anatomico della struttura del piede e la positività per anticorpi anti-CCP e FR, entrambi noti fattori di rischio per malattia a decorso più aggressivo (3,4).…”

“…In questo contesto, la determinazione del fattore reumatoide (FR) e, soprattutto, degli anticorpi anti-citrullina (anti-CCP) rappresentano, alla luce di numerose evidenze in letteratura, dei validi indici non solo diagnostici ma anche prognostici di malattia (3,4). Il distretto più frequentemente colpito è l'avampiede dove si riscontrano segni e sintomi legati al danno anatomico che si crea, quali dolore, deformità e limitazione funzionale.…”