AUTOANTIBODIES - PREDICTORS OF AGGRESSIVE RHEUMATOID ARTHRITIS

Background: Rheumatoid arthritis (RA) is characterized by a broad spectrum of autoantibodies detected in patients'sera. Their diagnostic and prognostic value vary in terms of progression and aggressiveness of the disease.Objectives: To evaluate the contribution of serological parameters for the prediction of progressive and erosive development in patients with early RA.Methods: Fifty one patients (49 female, 2 male; mean age 41.9±3.6 years) satisfying the 1987 ACR classification criteria and with less than 12 months'disease duration, were examined for the presence of the following autoantibodies by immuno-enzyme assays: anti-cyclic citrullinates peptide (CCP) (Axis-Shield Diagnostics Ltd. UK), rheumatoid factor (RF)-IgM, anti-dsDNA, anti-SS-A, antri-SS-B, anti-Sm/RNP, ANCA-MPO (Trinity Biotech USA); and generic antinuclear antibodies (ANA – IFA). Radiographs of hands and feet taken at entry and at 36th month were evaluated with the method of Larsen. The data were processed by SPSS-98 statistical programme where descriptive and non-parametric analyses were used. The Odds ratios (OR) were determined with 95% confidence intervals (CI).Results: The patients were divided into 2 groups according to X-rays, taken at 36th month - group A (32 patients, 62.7%, Larsen score >2, with radiographic progression) and group B (19 patients, 37.3%, Larsen score <2 with radiographic non-progression). Autoantibodies tested as serological risk factors of aggressive RA are presented in Table. Serological risk factors of aggressive RA Positive Ab Group A Group A OR Group B Group B n % of all 95% CI n % of all anti-CCP 31 60.8 3.36 (1.4-9.1) 6 11.8 RF-IgM 21 41.2 2.12 (0.9-6.3) 9 18.6 generic ANA 2 3.9 0.57 (0.2-1.9) 2 3.9 anti-dsDNA 0 0 0 0 0 anti-SS-A (Ro) 2 3.9 0.57 (0.2-1.9) 0 0 anti-SS-B (La) 2 3.9 0.57 (0.2-1.9) 0 0 anti-Sm/RNP 0 0 0 1 2 ANCA-MPO 0 0 0 1 2 ld]Conclusion: Both anti-CCP and RF-IgM, detected in patients with early RA, can serve as serological predictors for aggressive disease. We suggest that patients with early RA and above autoantibodies would develop erosive disease which implies early and aggressive treatment with disease-modifying anti-rheumatic drugs.References: 1. Aman S, Paimela L, Leirisalo-Repo M et al. Prediction of disease progression in early rheumatoid arthritis by ICTP, RF and CRP. A comparative 3-year follow-up study. Rheumatology 2000;39:1009-10132. Combe B, Cantagrel A, Coupille P et al. Predictive factors of 5-year health assessment questionnaire disability in early rheumatoid arthritis. J Rheumatol 2003;30:2344-23493. Jacoby RK, Jayson M, Cosh JA. Onset, early stages and prognosis of rheumatoid arthritis: a clinical study of 100 patiens with 11-year follow-up. Br Med Journal 1973;2:96-1004. Mottonen T, Paimela L, Leirisalo-Repo M et al. Only high disease activity and positive rheumatoid factor indicate poor prognosis in patients with early rheumatoid arthritis treated with "sawtooth "strategy. Ann Rheum Dis 1998;57:533-5395. Zeng X, Ai M, Tian X et al. Diagnostic value of anti-cyclic citrullinated peptide antibody in patients with rheumatoid arthritis J Rheumatol 2003;30:1451-1455Citation: , volume , supplement , year 2004, page Session: Rheumatoid arthritis – Clinical aspects