RESEARCH - Prediction of erosive disease in early RA

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The significance of antibodies to cyclic citrullinated peptide,

antikeratin antibodies, anti-perinuclear factor, rheumatoid factor isotypes

and HLA shared epitope in prediction of erosive disease in early rheumatoid

arthritis patients

J Vencovsky, L Sedova, S Machacek, J Gatterova, V Pesakova, J Kafkova

and O Krystufkova

Institute of Rheumatology, Prague, Czech Republic

from 21st European Workshop for Rheumatology Research

Vienna, Austria, 1-4 March 2001

Arthritis Res 2001, 3(Suppl A):P002 doi:10.1186/ar171

Received 15 January 2001

Published 26 January 2001

© 2001 BioMed Central Ltd

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Objectives

To evaluate a predictive value of autoantibody examinations in

development of erosive disease in early rheumatoid arthritis (RA).

Patients and methods

One hundred and fourteen patients with disease duration less than 2

years after the onset of symptoms were investigated. Only patients who

fulfilled the diagnostic criteria for RA either at the beginning of the

disease or during the follow-up period were included. The antibodies to

cyclic citrullinated peptide (anti-CCP) (Immunoscan RA, Euro-diagnostica,

The Netherlands), IgM, IgA and IgG rheumatoid factors (RF) were measured by

ELISA, antikeratin antibodies (AKA) and antiperinuclear factor (APF) were

detected by indirect immunofluorescence, and the presence of HLA shared

epitope (HLA SE) was detected by PCR with sequence specific primers.

Patients were divided into two groups, either with erosive or non-erosive

changes present on the hand or/and feet radiographs at the end of 24 months

follow-up.

Results

Seventy-six (66.7%) patients developed bony erosion, whereas 38

(33.3%) remained without destructive changes. The initial anti-CCP, AKA,

APF, IgM RF, IgA RF, IgG RF and HLA SE were positive in 50 %, 46 %, 42%,

54%, 47%, 43% and 67 % in erosive group, and in 19%, 14%, 22%, 30%, 27%, 24%

and 65% in non-erosive group, respectively. The significant differences

between erosive and non-erosive groups were detected for anti-CCP, AKA, IgM

RF and IgA RF. The levels of anti-CCP were significantly higher in erosive

early RA group (159.1 ± 224.0 units) vs. non-erosive one (85.8 ± 164.8).

Similarly, patients with erosive disease had significantly higher levels of

IgM RF, IgA RF and IgG RF (3,1 ± 2.8; 2.8 ± 2.6; 2.8 ± 2.6) in comparison

with patients without erosions (1.9 ± 2.0; 1.8 ± 2.6; 2.1 ± 2.8).

Conclusions

The data showed that a measurement of anti-CCP, individual isotypes of

RFs and to a less extent AKA, could be useful for prediction of disease

development in the early cases of RA.

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