RESEARCH - Differential response of the RF and anti-CCP antibodies during Humira treatment in patients with RA

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J Rheumatol. 2008 Sep 1. [Epub ahead of print]

Differential Response of the Rheumatoid Factor and Anticitrullinated

Protein Antibodies During Adalimumab Treatment in Patients with

Rheumatoid Arthritis.

Bos WH, Bartelds GM, Wolbink GJ, de Koning MH, van de Stadt RJ, van

Schaardenburg D, Dijkmans BA, Nurmohamed MT.

From Jan van Breemen Instituut; Sanquin Research; and VU University

Medical Center, Department of Rheumatology, Amsterdam, The

Netherlands.

OBJECTIVE: To investigate the effect of anti-tumor necrosis factor

(TNF) treatment on rheumatoid factor (IgM-RF) and anticitrullinated

protein antibodies (ACPA) and its association with treatment response

and acute-phase reactants.

METHODS: In a cohort of 188 consecutive patients with rheumatoid

arthritis (RA) treated with adalimumab, baseline IgM-RF and ACPA were

determined by ELISA, and compared to levels after 28 weeks of

treatment. ACPA were measured as antibodies to cyclic citrullinated

peptide (anti-CCP). The relative change of antibody levels was

correlated to the European League Against Rheumatism response criteria

and to the change in acute-phase reactants [erythrocyte sedimentation

rate (ESR) and C-reactive protein (CRP)].

RESULTS: The median decline in IgM-RF levels was greater than the

decline in ACPA levels (31% vs 8%; p < 0.001). The decrease in

antibody levels was greater in the group of good responders than in

the group of nonresponders [43% vs 7% for IgM-RF (p < 0.0001) and 16

vs -4% for ACPA (p = 0.03)]. Seventeen percent of IgM-RF-positive

patients at baseline turned negative at 28 weeks; this qualitative

effect was not observed for ACPA. Further, the decline in IgM-RF, but

not ACPA, was associated with a decrease in CRP and ESR (p = 0.004 and

p = 0.006, respectively).

CONCLUSION: TNF treatment directly influences IgM-RF and ACPA levels,

but in those responding to treatment only. The effect on IgM-RF levels

and positivity status is greater than on ACPA levels and is associated

with the decline in markers of inflammation. These results further

emphasize the differential role these autoantibodies may play in RA;

IgM-RF as marker of inflammatory activity, and ACPA as qualitatively

stable hallmark of RA.

PMID: 18785316

http://www.ncbi.nlm.nih.gov/pubmed/18785316

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