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RESEARCH - Autoantibody profiling in patients with very early RA - a follow-up study

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Ann Rheum Dis. Published Online First: 19 January 2009.

doi:10.1136/ard.2008.100677

Copyright © 2009 BMJ Publishing Group Ltd & European League Against

Rheumatism

--------------------------------------------------------------------------------

Extended Report

Autoantibody profiling in patients with very early rheumatoid

arthritis - a follow-up study

Nell-Duxneuner 1, Klaus Machold 1, Tanja Stamm 1, e

Eberl 2, Harald Heinzl 1, beth Hoefler 2, f S Smolen 1 and

Guenter Steiner 1*

1 Medical University of Vienna, Austria

2 Hietzing Hospital, Austria

Abstract

Objective: To investigate time courses of autoantibody profiles in

patients with early arthritis.

Patients and methods: Two hundred patients with very early arthritis

(<3 months duration), among them 102 patients with a final diagnosis

of rheumatoid arthritis (RA) and 98 with other rheumatic diseases,

were followed up for several years. First follow-up testing was done

in all patients (mean 5 months from baseline), and 82 RA and 35 non-RA

patients were available for last follow-up testing (mean 32 months

from baseline). IgM-rheumatoid factor (RF) was measured by

nephelometry, IgA-RF, IgG-RF and anti-citrullinated peptide antibodies

(ACPA) by ELISA, and anti-RA33 antibodies were determined by

immunoblotting.

Results: At baseline, IgA-RF was detectable in 29% and IgG-RF in 14%

of RA patients while IgM-RF>50 IU/ml (RF50) was positive in 45% of the

patients; specificities were 97%, 99% and 96%, respectively. However,

the vast majority of IgA- or IgG-RF positive patients were also

positive for RF50 or ACPA. During follow-up prevalence of ACPA

slightly increased while prevalence of all RF subtypes and anti-RA33

decreased. Remarkably, the number of patients positive for RF50 and/or

ACPA remained constant; and these patients had a highly increased risk

for developing erosive disease, in contrast to patients solely

positive for anti-RA33.

Conclusions: Testing for RF subtypes did not provide additional

diagnostic information. Patients positive for RF50 and/or ACPA had an

unfavourable prognosis, irrespectively of changes in the antibody

profile during follow-up, whereas anti-RA33 positivity was inversely

associated with erosiveness both at baseline and at later time points.

http://ard.bmj.com/cgi/content/abstract/ard.2008.100677v1?papetoc

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