RESEARCH - Anti-CCP antibodies measured at disease onset help identify seronegative RA and predict outcome

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Rheumatology Advance Access originally published online on November 15, 2005

Rheumatology 2006 45(4):478-480; doi:10.1093/rheumatology/kei203

© The Author 2005. Published by Oxford University Press on behalf of the

British Society for Rheumatology. All rights reserved. For Permissions,

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Anti-CCP antibodies measured at disease onset help identify seronegative

rheumatoid arthritis and predict radiological and functional outcome

M. A. Quinn, A. K. S. Gough, M. J. Green, J. Devlin, E. M. A. Hensor, A.

Greenstein, A. Fraser and P. Emery

Academic Unit of Musculoskeletal Disease, Department of Rheumatology, Chapel

Allerton Hospital, Chapeltown Road, Leeds LS74SA, UK.

Correspondence to: M. A. Quinn. E-mail: Mark.Quinn@...

Objective. Anti-cyclic citrullinated peptide (anti-CCP) antibodies have been

identified as highly specific for rheumatoid arthritis (RA). Studies suggest

an association with radiographic outcome. The aims of this study were to

assess the diagnostic and prognostic utility of the second-generation

anti-CCP2 test in a large cohort of early RA patients compared with

connective tissue disease (CTD) controls.

Methods. One hundred and eighty-two patients with RA and 121 patients with

CTD were recruited. All RA patients had less than 24 months of symptoms and

had CRP, rheumatoid factor (RF), HLA typing (SE) and anti-CCP2 antibodies

measured at baseline. Function was assessed using the Health Assessment

Questionnaire (HAQ) and X-rays performed at 0, 12 and 24 months.

Results. The anti-CCP2 antibody test demonstrated a specificity of 91% and

sensitivity of 81% for RA when compared with controls. In RF-negative

patients, specificity was 92% and sensitivity 60%. Baseline demographics of

the RA cohort showed mean age 57 yr, mean symptom duration 7 months, 63%

RF-positive patients, 72% SE-positive, 81% CCP-positive and 21% erosive. The

only predictor of change in Larsen score from 0 to 24 months in the cohort

was the presence of the shared epitope (P<0.05) and in the RF-negative

subgroup it was CCP2 antibody titre >100 (P<0.05). Baseline HAQ was the only

significant predictor of HAQ at 24 months, but in the RF-negative subgroup

CCP2 antibody titre >100 predicted a poor functional response at 24 months

(P<0.05).

Conclusions. This study confirms the diagnostic utility of anti-CCP2

antibodies in early RA, particularly in seronegative patients, in whom

anti-CCP2 positivity also conferred prognostic utility for radiographic and

functional outcomes.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/45/4/478

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