ASSOCIATON OF ANTI-CYCLIC CITRULLINATED PEPTIDE 2 ANTIBODY (ANTI-CCP2) WITH DISEASE ACTIVITY PARAMETERS, FUNCTIONAL DISABILITY AND EXTRAARTICULAR INVOLVEMENT IN PATIENTS WITH RHEUMATOID ARTHRITIS

A. Ates, Y. Karaaslan, E. Ertugrul, S. AksarayRheumatology Microbiology, Ankara Numune Training and Research Hospital, Ankara, TurkeyObjectives: To investigate the association of the anti-CCP antibody with clinical and serological parameters of disease activity and functional disability in patients with rheumatoid arthritis (RA). We also evaluated the relation between the anti-CCP antibody and extraarticular involvement in patients with RA. Methods: In a cross-sectional study, a total of 313 patients with RA patients (248 female and 65 male) were enrolled in the study. Mean age was 50.1 years and mean disease duration was 79.4 months. The following disease activity parameters were determined: Tender joints count (TJC), swollen joints count (SJC), visual analog scale (VAS) for pain (0-10 cm), duration of morning stiffness, disease activity (DAS28) score, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Patient's and physician's global assessment were measured with VAS (0-10 cm). Functional assessment was carried out using the Health Assessment Questionnaire (HAQ). Schirmer's test for assessment of dry eye and high resolution computed tomography for assessment of lung involvement were used. Results: Rheumatoid factor (RF) was positive in 54% of the RA patients. Anti-CCP2 antibody was positive in 62.3% of the RA patients. One hundred and ten patients (35%) had extraarticular involvement. Seventy-five patients (24%) had sjögren's syndrome. Forty-four patients (14%) had lung involvement. Nine patients (2.9%) had rheumatoid nodules. In patients with RA, significant correlations were found between serum anti-CCP level and age (p<0.05), SJC (p<0.001), TJC (p<0.001), VAS for pain (p<0.05), patient's and physician's global assessment (p<0.05), HAQ score (p<0.05), DAS28 score (p<0.001), ESR (p<0.05) and RF level (p<0.01). RA patients with anti-CCP positive had significantly higher age (51.4 years vs. 47.9 years, respectively, p<0.05), SJC (2.1±3.4 vs. 1.1±1.8, respectively, p<0.001), morning stiffness (55±70 min vs. 40±54 min, respectively, p<0.05), physician's global assessment (4.0±6.8 cm vs. 2.9±2.8 cm, respectively, p<0.05), HAQ score (0.74±0.70 vs. 0.49±0.54, respectively, p<0.001), DAS28 score (4.1±1.7 vs. 3.5±1.4, respectively, p<0.01), CRP (20.0±29.2 mg/l vs. 14.2±21.4 mg/l, respectively, p<0.05), ESR (29±23 mm/h vs. 23±22 mm/h, respectively, p<0.05), RF level (146±234 IU/ml vs. 43±92 IU/ml, respectively, p<0.001) compared to RA patients with anti-CCP negative. The frequency of anti-CCP2 antibody positivity in RA patients with extraarticular involvement was significantly higher than that in RA patients without extraarticular involvement (72.5% vs. 55.8%, respectively, p<0.01) whereas anti-CCP2 level was not. Anti-CCP2 antibody level and positivity in RA patients receiving methotrexate (Mtx) therapy were significantly higher than those in RA patients not receiving Mtx. Conclusion: Anti-CCP2 antibody was significantly associated with parameters of disease activity, functional disability and extraarticular involvement in patients with RA. It is suggested that anti-CCP2 antibody may be a useful indicator of aggressive disease in patients with RA. Disclosure of Interest: None declaredCitation: Annals of the Rheumatic Diseases, volume 68, supplement 3, year 2009, page 217Session: Rheumatoid arthritis Prognosis, predictors and outcome (Poster Presentations )