REVIEW - Lack of seroconversion of RF and anti-CCP in patients with early inflammatory arthritis

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Rheumatology (2011) 50 (2): 311-316.

Lack of seroconversion of rheumatoid factor and anti-cyclic

citrullinated peptide in patients with early inflammatory arthritis: a

systematic literature review

Lillian Barra1, Janet Pope1, Louis Bessette2, Boulos Haraoui3 and Vivian Bykerk4

1Department of Medicine, Division of Rheumatology, University of

Western Ontario, London, ON, 2Department of Medicine, Laval

University, Quebec City, 3Department of Rheumatology, University of

Montreal, Montreal, QC and 4Department of Rheumatology, University of

Toronto, Toronto, ON, Canada.

Received November 9, 2009.

Revision received May 18, 2010.

Abstract

Objective. Serological markers are thought to be useful in predicting

which patients with early inflammatory arthritis (EIA) will progress

to RA. The objective of this study is to determine the per cent RF and

anti-CCP seroconversion in EIA patients at 1–5 years of follow-up: 80%

of established RA is RF or CCP positive.

Methods. We conducted a systematic literature review of all English

publications and recent abstracts from ACR and EULAR. Patients ≥16

years of age with at least one swollen joint and symptoms < 2 years

were included.

Results. Twelve publications met the criteria: 10 studies included

data on RF, while only 5 addressed anti-CCP. Sample sizes ranged from

15 to 395 and follow-up was 6–60 months. There was marked

heterogeneity between studies; therefore, results could not be pooled

for a meta-analysis. Baseline RF and anti-CCP positivity was also

highly variable: 8–55 and 4–45%, respectively. Seroconversion rates

for EIA were 1.9–5.0% at up to 30 months follow-up for RF and 1.3–8.9%

at up to 60 months follow-up for anti-CCP.

Conclusion. There is minimal change in RF or anti-CCP positivity up to

5 years of follow-up. Prevalence data for RF in established RA is

significantly higher than the baseline values reported here. The low

rates of seroconversion would suggest a lower prevalence in EIA and

the reason for this difference remains unknown. It is unclear whether

antibody-negative patients are more likely to remit and be lost to

follow-up in established RA populations.

http://rheumatology.oxfordjournals.org/content/50/2/311.abstract?etoc

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