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

Abstract

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.

Role of Dickkopf-1 and Musculoskeletal Ultrasound in Bone Loss in Rheumatoid Arthritis

“…This was in agreement with the main finding in Grandaunet et al, their study enrolled 238 patients with RA, that Dkk1 levels at baseline were significantly higher (2010 pg/mL) in patients developing per articular bone loss compared with patients without per articular bone loss (1332.2 pg/mL, P<0.05) [25]. There was also negative correlation between s.DKK-1 levels and forearm T-score, lumbar T-score and neck of femur T-score, moreover a difference was found in serum Dkk1 levels between DEXA grading (normal, osteopenic, osteoporotic) but didn't reach a statistical significant level(H=0.91, P>0.05).…”

Anti-CCP antibodies are not a marker of severity in established rheumatoid arthritis: a magnetic resonance imaging study

“…[15][16][17][18][19][20][21][22][23] It is noteworthy that most of these studies used the Larsen or Sharp method in their radiographic evaluation. Håfström et al, 44 in a prospective study examining the role of RF and anti-CCP based on the radiological progression with the use of the SvdH method in patients with early RA, according to prednisolone use, found that RF and anti-CCP were predictors of radiographic progression only in patients who did not use steroids. Our work also did not establish an association of anti-CCP with structural damage, as assessed by SvdH in established RA cases, which is in accordance with Håfström et al's study, since 87.5% of our patients were still being medicated with prednisone.…”

Role and mechanism of vascular cell adhesion molecule-1 in the development of rheumatoid arthritis

“…Studies have shown that the descendants of patients with RA may have increased RF levels, even without exhibiting any RA symptoms, while infections caused by Mycoplasma and Streptococcus can also result in disorders of the autoimmune system, and thus induce RA (17,18). The diagnosis of RA is made based on the clinical symptoms of the patients, X-ray results and RF detection results, and the serum RF level is the only serological indicator of RA (19,20). VCAM-1 is an essential cell adhesion molecule and its expression can be induced by inflammatory cytokines, such as IL-6 and TNF, which participate in the differentiation and development of lymphocytes and are associated with the pathological processes of several diseases, including systemic inflammation, tumor invasion and metastasis, autoimmune diseases and parasitic infections (21,22).…”