RESEARCH - Autoantibody profiling as early diagnostic and prognostic tool for rheumatoid arthritis

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Ann Rheum Dis. 2005 Dec;64(12):1731-6. Epub 2005 May 5.

Autoantibody profiling as early diagnostic and prognostic tool for

rheumatoid arthritis.

Nell VP, Machold KP, Stamm TA, Eberl G, Heinzl H, Uffmann M, Smolen JS,

Steiner G.

Department of Rheumatology, Internal Medicine III, Medical University of

Vienna, Waehringer Guertel 18-20, A-1090 Austria.

BACKGROUND: Early treatment prevents progression of joint damage in

rheumatoid arthritis (RA), but diagnosis in early disease is impeded by lack

of appropriate diagnostic criteria. OBJECTIVE: To study the value of

rheumatoid factor (RF), anti-cyclic citrullinated peptide autoantibodies

(anti-CCP), and anti-RA33 autoantibodies for diagnosis of RA and prediction

of outcome in patients with very early arthritis. METHODS: The prospective

follow up inception cohort included 200 patients with very early (<3 months)

inflammatory joint disease. Autoantibodies were measured at baseline and

analysed in a tree based model which aimed at determining the added

diagnostic value of testing for anti-CCP and anti-RA33 as compared with RF

alone. RESULTS: RA was diagnosed in 102 patients, while 98 developed other

inflammatory arthropathies. Receiver operator curve analysis showed an

optimum cut off level for RF at 50 U/ml, above which anti-CCP and anti-RA33

had no additional diagnostic value. Remarkably, RF >or=50 U/ml and anti-CCP

showed similar sensitivity and high specificity for RA, but overlapped

considerably. Anti-RA33 was less specific and did not correlate with RF or

anti-CCP. Among patients with RA, 72% showed at least one of these three

autoantibodies, compared with 15% of non-RA patients. RF >or=50 U/ml and

anti-CCP were predictors of erosive disease, whereas anti-RA33 was

associated with mild disease.

CONCLUSIONS: Stepwise autoantibody testing in

early inflammatory joint disease, starting with RF, followed by anti-CCP (in

patients with RF <50 U/ml), and finally anti-RA33, should be used as a

sensitive and effective strategy for distinguishing patients with RA at high

risk for poor outcome.

PMID: 15878904

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=15878904 & itool=iconabstr & query_hl=3 & itool=pubmed_DocSum

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