Serum IgA rheumatoid factor and pyridinoline in very early arthritis as predictors of erosion(s) at two years: A simple model of prediction from a conservatively treated community‐based inception cohort

Abstract

Objective. To identify, in conservatively treated, very early arthritis patients, predictors of >1 erosion(s) at 2 years, and to construct a prediction model. Methods. Community-based adults (n ‫؍‬ 310) who had never taken disease-modifying antirheumatic drugs (DMARDs) or steroids with swelling of >2 joints persisting for >4 weeks and lasting <6 months were recruited. Erosion status was assessed at 0, 6, 12, and 24 months; evaluations were comprised of clinical criteria (Disease Activity Score, Health Assessment Questionnaire), C-reactive protein level, erythrocyte sedimentation rate, autoantibodies, bone and cartilage markers, hand densitometry, and HLA class II shared epitopes. Patients meeting American College of Rheumatology rheumatoid arthritis (RA) criteria or with undifferentiated arthritis (UA) were followed and treated conservatively: one-third of RA patients and three-fourths of UA patients received no DMARDs during 2 years; a biologic agent was given to 1.8% of the patients during the first year. The main judgment criterion was >1 erosion(s) at 2 years. Results. At 2 years, 219 patients were assessed; 31.3% with RA and 10.6% with UA had >1 erosion(s). Logistic regression analysis at that time showed erosion(s) strongly associated with serum IgA rheumatoid factor (IgA-RF) and pyridinoline levels for the 190 patients with no baseline erosions, with the corresponding receiver operating characteristic curve having an area under the curve of 0.77 (95% confidence interval 0.64 -0.86). A prediction model was constructed with IgA-RF thresholds of 5 and 25 IU/ml and a pyridinoline threshold of 10 nM/liter; odds ratios ranged from 1 for IgA-RF <5 IU/ml and pyridinoline <10 nM/liter to 50.75 for the association of IgA-RF >5 IU/ml and pyridinoline >10 nM/liter. Conclusion. This model, using serum IgA-RF and pyridinoline concentrations, was able to predict >1 erosion(s) at 2 years in very early arthritis patients.

A cross sectional study of bone and cartilage biomarkers: correlation with structural damage in rheumatoid arthritis

“…In fact, Loët et al (2010) showed that IgA-Rheumatoid factors and pyridinoline, were risk factors for erosions when their levels were simultaneously elevated [22]. The same results were reported by Krabben et al (2013) which found that increased pyridinoline serum levels, both at baseline and during the disease course, were associated with more severe joint damage during the following year s [23].…”

Validation of the 2010-ACR/EULAR – classification criteria using newly EULAR-defined erosion for rheumatoid arthritis on the very early arthritis community-based (VErA) cohort

“…It comprised 310 patients: male or female, age ≥ 18 years; ≥ 2 swollen joints, swelling persisting for > 4 weeks, symptoms lasting < 6 months; no previous glucocorticoid prescription [only one intra-articular injection > 1 month before or oral prednisone (<10 mg/day) for 1 week > 2 weeks before enrollment were tolerated] or disease-modifying antirheumatic drugs (DMARDs); no inflammatory back pain; no foreseen move during the 10 next years. The protocol recommended conservative treatment within the first two years [8]. This study was approved by the Upper Normandy Ethics Committee (file 95/138/HP).…”

“…The VErA cohort was described previously [8]. Briefly, this community-based, inception cohort was recruited between 1998 and 2002 in two French regions.…”

Mice overexpressing BAFF develop a commensal flora–dependent, IgA-associated nephropathy

“…Serum IgA anti-gluten and anti-transglutaminase antibodies are observed in celiac disease, and serum IgA levels can be elevated in inflammatory bowel disease (7,8). IgA pemphigus appears to be driven by direct autoreactivity, and the circulating level of IgA rheumatoid factor has a high prognostic value in rheumatoid arthritis (9,10). In so-called seronegative lupus nephritis, a "full house" nephropathy pattern can be frequently observed that includes IgA deposition in the glomeruli (11).…”