Autoantibodies to CCP predict progression to RA in patients with undifferentiated arthritis

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Arthritis Rheum. 2004 Mar;50(3):709-15.

Autoantibodies to cyclic citrullinated peptides predict progression to

rheumatoid arthritis in patients with undifferentiated arthritis: a

prospective cohort study.

van Gaalen FA, Linn-Rasker SP, van Venrooij WJ, de Jong BA, Breedveld

FC, Verweij CL, Toes RE, Huizinga TW.

Department of Rheumatology, Leiden University Medical Center, Leiden,

The Netherlands. f.a.van_gaalen@...

OBJECTIVE: Rheumatoid arthritis (RA) is a common, severe, chronic

inflammatory joint disease. Since the disease may initially be

indistinguishable from other forms of arthritis, early diagnosis can be

difficult. Autoantibodies seen in RA can be detected years before

clinical symptoms develop. In an inception cohort of patients with

recent-onset arthritis, we undertook this study to assess the predictive

value of RA-specific autoantibodies to cyclic citrullinated peptides

(CCPs) in patients with undifferentiated arthritis (UA). METHODS:

Anti-CCP2 antibody tests were performed at baseline in 936 consecutive,

newly referred patients with recent-onset arthritis. Patients who could

not be properly classified 2 weeks after inclusion were categorized as

having UA. Patients with UA were followed up for 3 years and evaluated

for progression of their disease to RA as defined by the American

College of Rheumatology (ACR) 1987 revised criteria. RESULTS: Three

hundred eighteen of 936 patients with recent-onset arthritis were

classified as having UA and were available for analysis. After 3 years

of followup, 127 of 318 UA patients (40%) had been classified as having

RA. RA had developed in 63 of 249 patients (25%) with a negative

anti-CCP test and in 64 of 69 patients (93%) with a positive anti-CCP

test (odds ratio 37.8 [95% confidence interval 13.8-111.9]).

Multivariate analysis of the presence of anti-CCP antibodies and

parameters from the ACR criteria identified polyarthritis, symmetric

arthritis, erosions on radiographs, and anti-CCP antibodies as

significant predictors of RA.

CONCLUSION: Testing for anti-CCP antibodies in UA allows accurate

prediction of a substantial number of patients who will fulfill the ACR

criteria for RA.

PMID: 15022309

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