Abstract
IntroductionWe wanted to assess the importance of the levels of anti-citrullinated peptide antibody (anti-CCP) and immunoglobulin M (IgM) rheumatoid factor (RF) in predicting development of persistent arthritis from undifferentiated arthritis (UA), and to investigate whether there is an added predictive value for persistent arthritis in testing for both anti-CCP and IgM RF.MethodsPatients with UA (exclusion of definite non-rheumatoid arthritis (RA) diagnoses) included in the Norwegian very early arthritis clinic were assessed for development of persistent arthritic disease. The effect of antibody level on the likelihood of persistent arthritis was investigated, and the sensitivity and specificity for persistent arthritis for anti-CCP and IgM RF, separately and combined, was determined.ResultsA total of 376 UA patients were included (median arthritis duration 32 days). 59 (15.7%) patients were IgM RF positive, and 62 (16.5%) anti-CCP positive. One hundred, seventy-four (46.3%) had persistent disease after one year. Overlap of anti-CCP and IgM RF positivity was 58%. Sensitivity/specificity for persistent arthritis was 28/95% for IgM RF alone, 30/95% for anti-CCP alone, and 37/92% for positivity of both anti-CCP and IgM RF. The likelihood for persistent disease increased with increasing levels of both anti-CCP and IgM RF.ConclusionsThe likelihood of developing persistent arthritis in UA patients increases with the level of anti-CCP and IgM RF. Testing both anti-CCP and IgM RF has added predictive value in UA patients. This study suggests that antibody level should be taken into account when making risk assessments in patients with UA.
Highlights
We wanted to assess the importance of the levels of anti-citrullinated peptide antibody and immunoglobulin M (IgM) rheumatoid factor (RF) in predicting development of persistent arthritis from undifferentiated arthritis (UA), and to investigate whether there is an added predictive value for persistent arthritis in testing for both anti-CCP and IgM RF
Baseline information about anti-CCP and IgM RF was available in 483/572 (84%) patients enrolled in the study
Eighty-nine patients were excluded from the analysis because they were diagnosed with a specific rheumatological non-rheumatoid arthritis (RA) condition at the initial assessment (Löfgren's syndrome/sarcoidosis-associated arthritis 39, psoriatic arthritis according to the Moll & Wright criteria for psoriatic arthritis (PsA) [24] 38, gout 10, ulcerative colitis-arthritis 1, polymyalgia rheumatica 1)
Summary
We wanted to assess the importance of the levels of anti-citrullinated peptide antibody (anti-CCP) and immunoglobulin M (IgM) rheumatoid factor (RF) in predicting development of persistent arthritis from undifferentiated arthritis (UA), and to investigate whether there is an added predictive value for persistent arthritis in testing for both anti-CCP and IgM RF. Rheumatoid factor (RF) has traditionally been regarded as the main serologic marker in inflammatory arthritis [1,2]. In recent years anti-citrullinated protein antibodies (ACPA), most commonly measured by assays for antibodies against cyclic citrullinated peptide (anti-CCP), have been identified as important predictors both for diagnosis and prognosis in rheumatoid arthritis (RA). A few studies have identified anti-CCP or RF as predictors of persistent arthritis (as opposed to remission of disease) [13,14,15,16,17]
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