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- DOI: 10.1186/ar3834
- PMID: 22571727
- UKPMCID: 22571727
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Long-term stability of anti-cyclic citrullinated peptide antibody status in patients with early inflammatory polyarthritis.
Burr, Marian L; Viatte, Sebastien; Bukhari, Marwan; Plant, Darren; Symmons, Deborah P M; Thomson, Wendy; Barton, Anne
Arthritis research & therapy. 2012;14(3):R109.
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Full-text held externally
- DOI: 10.1186/ar3834
- PMID: 22571727
- UKPMCID: 22571727
Abstract
ABSTRACT: INTRODUCTION: The utility of reassessing anti-cyclic citrullinated peptide (anti-CCP) antibody status later in disease in patients presenting with early undifferentiated inflammatory polyarthritis, particularly in those who test negative for both anti-CCP and rheumatoid factor (RF) at baseline, remains unclear. We aimed therefore to determine the stability of CCP antibody status over time and the prognostic utility of repeat testing in subjects with early inflammatory polyarthritis (IP). METHODS: Anti-CCP and RF were measured at baseline and 5 years in 640 IP patients from the Norfolk Arthritis Register, a primary care based inception cohort. The relationship between change in anti-CCP status/titre and the presence of radiological erosions, the extent of the Larsen score and Health Assessment Questionnaire (HAQ) score by 5 years was investigated. RESULTS: Using a cut-off of 5 U/ml, 28% subjects tested positive for anti-CCP antibodies, 29% for RF and 21% for both at baseline. Nine (2%) anti-CCP negative patients seroconverted to positive and 9 (4.6%) anti-CCP positive individuals became negative between baseline and 5 years. In contrast, RF status changed in 17% of subjects. However, change in RF status was strongly linked to baseline anti-CCP status and was not independently associated with outcome. Ever positivity for anti-CCP antibodies by 5 years did not improve prediction of radiographic damage compared to baseline status alone (accuracy 75% vs 74%). A higher baseline anti-CCP titre (but not change in anti-CCP titre) predicted worse radiological damage at 5 years (P <0.0001), even at levels below the cut-off for anti-CCP positivity. Thus, a titre of 2-5U/ml was strongly associated with erosions by 5 years (odds ratio 3.6 (1.5,8.3); P = 0.003). CONCLUSIONS: Repeat testing of anti-CCP antibodies or RF in patients with IP does not improve prognostic value and should not be recommended in routine clinical practice.