Anti-CCP antibody test predicts the disease course during 3 years in early RA (the Swedish TIRA project)

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Ann Rheum Dis. 2004 Sep;63(9):1085-9.

Anti-CCP antibody test predicts the disease course during 3 years in

early rheumatoid arthritis (the Swedish TIRA project).

Kastbom A, Strandberg G, Lindroos A, Skogh T.

Division of Rheumatology/AIR, Department of Molecular and Clinical

Medicine, Faculty of Health Sciences, Linkoping University Hospital,

SE-581 85 Linkoping, Sweden. thomas.skogh@...

OBJECTIVES: To evaluate the diagnostic sensitivity of antibodies to

cyclic citrullinated peptide (CCP) in recent onset rheumatoid arthritis

(RA) at diagnosis and 3 years later, and to evaluate anti-CCP antibody

as a predictor of the disease course during 3 years. METHODS: 242

patients with recent onset (</=1 year) RA were followed up regularly

during 3 years after inclusion in the Swedish multicentre study " TIRA "

1996-98. Anti-CCP antibodies were analysed by an enzyme immunoassay

(EIA). Rheumatoid factors (RFs) were analysed by latex agglutination and

two isotype-specific (IgM and IgA) EIAs. Disease activity was assessed

by plasma CRP, ESR, 28 joint disease activity score, and the physician's

global assessment of disease activity. Functional ability was evaluated

by the Health Assessment Questionnaire. RESULTS: Overall, the diagnostic

sensitivity of anti-CCP antibodies was 64% and the proportion of

positive tests increased with the number of fulfilled classification

criteria according to the American College of Rheumatology. The anti-CCP

antibody results correlated with RF, but were better than RF as

predictor of a more aggressive disease course. After 3 years 5/97

patients had changed anti-CCP status: 2 from negative to positive and 3

from positive to negative. The mean level of anti-CCP antibodies

declined by 131 U/ml during the 3 year follow up (95% CI 34 to 228

U/ml).

CONCLUSION: The anti-CCP antibody assay has a similar diagnostic

sensitivity to that of RF in early RA, but is better as a predictor of

the disease course over 3 years. Although the mean serum level declines,

anti-CCP antibody positivity remains essentially unaltered 3 years after

diagnosis and start of antirheumatic treatment.

PMID: 15308517

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