RF, but not anti-CCP antibodies, is modulated by Remicade treatment in RA

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Ann Rheum Dis. 2004 May 27 [Epub ahead of print]

Rheumatoid factor, but not anti-citrullinated protein antibodies, is

modulated by infliximab treatment in Rheumatoid Arthritis.

De Rycke L, Verhelst X, Kruithof E, Van Den Bosch F, Hoffman IE, Veys

EM, De Keyser F.

Department of Rheumatology - Ghent University Hospital, Belguim.

BACKGROUND: Infliximab is effective in the treatment of rheumatoid

arthritis (RA). The effect of anti-TNFa therapy on RA-associated

auto-antibodies is not extensively evaluated. OBJECTIVES: To analyse 1)

the effect of infliximab on IgM-rheumatoid factor (RF) and anti-cyclic

citrullinated peptide (CCP) antibodies, and 2) whether baseline

autoantibody titres (IgM-RF and anti-CCP antibodies) are associated with

changes in acute phase reactants. PATIENTS AND METHODS: 62 patients with

refractory RA were treated with infliximab (3 mg/kg IV at week 0, 2, 6

and every 8 weeks thereafter) combined with methotrexate. At baseline

and week 30, sera were tested for IgM-RF by two agglutination assays,

and for anti-CCP antibodies by ELISA. The percentage change in C-

reactive protein (CRP) and Erythrocyte Sedimentation Rate (ESR) was

calculated. RESULTS: For both IgM-RF assays, there was a significant

reduction in RF titres during infliximab treatment (p<0.001 and p=0.038,

respectively), whereas anti-CCP antibodies were not modulated (p=0.240).

Baseline IgM-RF titres, but not anti-CCP antibodies, were inversely

correlated with changes in CRP and ESR during infliximab treatment.

Furthermore, we observed lower IgM-RF titres in patients with a marked

decrease in acute phase reactants (= at least 20% decrease in CRP and

ESR) compared to those with a less pronounced decrease in CRP and ESR.

Again, no statistically significant differences were found for anti-CCP

antibodies.

CONCLUSION: Both the differential effect of infliximab therapy on IgM-RF

and anti-CCP antibodies, and the different predictive value on changes

in acute phase reactants during infliximab treatment support the

existing evidence that RF and anti-citrullinated protein antibodies are

two different, independent auto-antibody systems in RA.

PMID: 15166003

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