Anticitrullinated Protein Antibodies and Rheumatoid Factor Fluctuate in Early Inflammatory Arthritis and Do Not Predict Clinical Outcomes

Barra, Lillian; Bykerk, Vivian P.; Pope, Janet; Haraoui, Boulos; Hitchon, Carol; Thorne, John; Keystone, Edward; Boire, Gilles; Investigators, Catch

doi:10.3899/jrheum.120736

Cited by 43 publications

(41 citation statements)

References 33 publications

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“…In a recent study by Barra et al 15 on early inflammatory arthritis, seroreversion occurred at rates similar to those in the present study without any influence on the prediction of outcome. However, in another early polyarthritis cohort, the prognostic significance of initial RF and anti-CCP positivity was influenced by seroreversion of these antibodies 16…”

Section: Discussionsupporting

confidence: 88%

Rheumatoid factor and anti-CCP do not predict progressive joint damage in patients with early rheumatoid arthritis treated with prednisolone: a randomised study

et al. 2014

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ObjectiveTo analyse if predictors of radiographic progression differ between patients treated with or without prednisolone in early rheumatoid arthritis (RA). Radiographs of hands and feet were assessed using the modified Sharp/van der Heijde score and radiographic progression was defined as an increase in the total Sharp score above 5.8 (the smallest detectable change).DesignProspective, randomised study of patients with early RA.SettingSecondary level of care; six participating centres from southern Sweden; both urban and rural populations.ParticipantsIn all, 225 patients, 64% women, with a diagnosis of RA according to the American College of Rheumatology criteria, were included if they were between 18 and 80 years of age and had a disease duration of less than 1 year.InterventionThe patients were randomised to 7.5 mg prednisolone daily for 2 years (P-group; n=108) or no prednisolone (NoP-group; n=117) when they started with their first disease-modifying anti-rheumatic drug and were prospectively followed for 2 years.ResultsThe frequency of patients with radiographic progression after 2 years was 26% in the P-group and 39% in the NoP-group (p=0.033). Relevant interactions between treatment and rheumatoid factor (RF) (p=0.061) and between treatment and anti-cyclic citrullinated peptide 2 (anti-CCP) (p=0.096) were found. RF and anti-CCP independently predicted radiographic progression only in the NoP-group, OR (95% CI) 9.4 (2.5 to 35.2), p=0.001 and OR (95% CI) 8.7 (2.5 to 31.3), p=0.001, respectively.ConclusionsThe presence of RF and anti-CCP predicted radiographic progression in patients not treated with prednisolone but failed to predict progression in patients treated with this drug. The data suggest that early treatment with prednisolone may modulate not only inflammation but also autoimmunity-associated pathogenetic mechanisms.Trial registration numberISRCTN20612367.

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Section: Discussionsupporting

confidence: 88%

Rheumatoid factor and anti-CCP do not predict progressive joint damage in patients with early rheumatoid arthritis treated with prednisolone: a randomised study

et al. 2014

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“…In contrast, Böhler et al 16 described response-associated ACPA declines in an RA cohort with mean disease duration of >5 years, but found no relation to disease duration. In a Canadian early arthritis cohort, anti-CCP antibody fluctuations did not relate to clinical outcome 17. Differences in study populations and follow-up strategies might underlie these somewhat discrepant results.…”

Section: Discussionmentioning

confidence: 84%

Changes in the anticitrullinated peptide antibody response in relation to therapeutic outcome in early rheumatoid arthritis: results from the SWEFOT trial

et al. 2014

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ObjectiveTo determine the relationship between changes in antibody levels towards citrullinated peptides derived from different candidate autoantigens and therapeutic outcome in early rheumatoid arthritis (RA).MethodsBaseline and 3-month serum samples from 316 patients with early RA enrolled in the Swedish Farmacotherapy (SWEFOT) trial were analysed for antibodies against cyclic citrullinated peptides (CCP) and citrullinated peptides derived from vimentin (cVim), fibrinogen (cFib) and α-enolase (CEP-1). At 3-month follow-up, methotrexate monotherapy-inadequate responders were randomised to add-on therapy with sulfasalazine and hydroxychloroquine or infliximab. In these patients, anticitrullinated peptide antibodies (ACPA) were also assessed at 12 and 24 months. The proportion of antibody-positive patients and relative changes in antibody levels were compared across ACPA specificities and related to therapeutic response and radiographic progression.ResultsDuring the 2-year follow-up, the proportion of patients testing positive declined significantly regarding antibodies to cVim, cFib and CEP-1, while anti-CCP antibody occurrence remained stable over time. Turning anti-cVim antibody negative was most common, and anti-cVim antibody seroreversion during the first three months associated with significantly less 2-year radiographic progression compared with patients who remained positive. Median antibody levels of all tested ACPAs declined uniformly during initial methotrexate therapy and following response to add-on therapy, with no significant relation to treatment regimen or radiographic progression.ConclusionsThe influence of early antirheumatic therapy on ACPA seroreversions was markedly different across specificities, and early disappearance of anti-cVim antibodies associated with better radiological outcome. Thus, these data suggest that the disappearance of particular ACPA reactivities may be beneficial in early RA.Trial registration numberWHO database at the Karolinska institute: CT20080004; and clinicaltrials.gov: NCT00764725.

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“…One of the most critical findings of this study was not the lack of knowledge about early RA itself, but rather about how to act upon early RA detection. GPs rely on blood test results over clinical presentation while 40% of patients with early RA might be rheumatoid factor negative (24). The challenge in general practice with a low incidence of early RA is to use assessment techniques that are useful for detection (25).…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

A general practice perspective on early rheumatoid arthritis management: A qualitative study from Flanders

Meyfroidt

Stevens

Lepeleire

et al. 2015

European Journal of General Practice

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Anticitrullinated Protein Antibodies and Rheumatoid Factor Fluctuate in Early Inflammatory Arthritis and Do Not Predict Clinical Outcomes

Abstract: RF and ACPA have the potential to revert and convert during the early course of disease. Fluctuations in RF and ACPA were not associated with clinical outcomes.

Cited by 43 publications

References 33 publications

Rheumatoid factor and anti-CCP do not predict progressive joint damage in patients with early rheumatoid arthritis treated with prednisolone: a randomised study

Rheumatoid factor and anti-CCP do not predict progressive joint damage in patients with early rheumatoid arthritis treated with prednisolone: a randomised study

Changes in the anticitrullinated peptide antibody response in relation to therapeutic outcome in early rheumatoid arthritis: results from the SWEFOT trial

A general practice perspective on early rheumatoid arthritis management: A qualitative study from Flanders

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