RESEARCH - Prediction of radiographic progression in RA and the role of anti-MCV antibodies

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Ann Rheum Dis. Published Online First: 30 July 2009.

doi:10.1136/ard.2009.113092

BMJ Publishing Group Ltd & European League Against Rheumatism.

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Extended Report

Prediction of radiographic progression in rheumatoid arthritis and the

role of antibodies against mutated citrullinated vimentin: results

from a ten-year prospective study

Silje W Syversen 1*, Guro L Goll 2, Désirée van der Heijde 3,

Landewé 4, Benedicte A Lie 5, Sigrid degård 1, Till Uhlig 1, Per Ivar

Gaarder 6 and Tore K Kvien 1

1 Department of Rheumatology, Diakonhjemmet Hospital, Norway

2 Diakonhjemmet Hospital, Norway

3 Department of Rheumatology, Leiden University Medical Centre,

Leiden, Netherlands

4 Department of Rheumatology, University Hospital Maastricht,

Maastricht, Netherlands

5 Institute of Immunology, Rikshospitalet University hospital, Oslo, Norway

6 Department of Immunology and Transfusion Medicine, University

Hospital Ullevål, Norway

Abstract

Objectives: Anti-citrullinated peptide antibodies (ACPA) are

established as useful predictors of radiographic progression in

rheumatoid arthritis (RA). The main objective of this study was to

test the prognostic capacity of the recently developed test for

anti-mutated citrullinated vimentin (anti-MCV).

Methods: A cohort of 238 RA patients was followed longitudinally for

10 years; 125 patients with complete X-ray sets were included in the

main analyses. Radiographs were scored according to the van der Heijde

modified Sharp score (SHS). Patients were analysed for anti-MCV and

anti-CCP, and were genotyped for HLA-DRB1 " shared epitope " (SE) and

PTPN22 1858T.

Results: Anti-MCV and anti-CCP were strongly associated both regarding

status and level. Both antibodies were associated to SE, but only

anti-MCV was significantly associated with PTPN22 1858T. A positive

anti-MCV test increased the odds of radiographic progression by 7.3

(95% CI 3.2-16.5) compared to 5.7 (2.6-12.5) for a positive anti-CCP.

Presence of MCV antibodies gave an average increase in the total SHS

of 30 U compared to an average increase of 25 U for the presence of

CCP antibodies. Anti-MCVs were more strongly associated to progression

in erosions than joint space narrowing. Associations remained after

adjustment for other predictors of radiographic progression. The odds

of progression increased with increasing anti-MCV level.

Conclusion: Presence of anti-MCV predicted joint damage, and the

strength of this prediction was at least as strong as for anti-CCP.

Antibody status showed a higher association to bone than to cartilage

destruction. This study also indicates that higher anti-MCV levels add

prognostic information compared to their mere presence or absence.

http://ard.bmj.com/cgi/content/abstract/ard.2009.113092v1?papetoc

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