Abstract
Anti-citrullinated peptide antibodies (ACPA) are the most specific known marker for rheumatoid arthritis (RA) in adults. ACPA develop several years before the first clinical manifestations of arthritis and are highly predictive of progression from undifferentiated arthritis to definite RA1, as demonstrated in several longitudinal cohort studies of patients with early undifferentiated arthritis. The presence of ACPA is among the 2010 American College of Rheumatology/European League Against Rheumatism criteria for persistent, nonerosive polyarthritis requiring methotrexate therapy. Of the 6 points needed to warrant methotrexate therapy, the presence of ACPA provides 2 points if the titer is low (2–3 times the upper limit of normal) and 3 points if the titer is high (more than 3 times the upper limit of normal). Thus, quantitative considerations are important when using ACPA for diagnostic purposes. ACPA also help to predict outcomes. In cross-sectional and longitudinal cohort studies of patients with early RA, the presence of ACPA was independent from the disease phenotype (presentation … Address correspondence to Dr. Meyer. E-mail: olivier.meyer{at}bch.aphp.fr
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