EDITORIAL - Which elements of the criteria for RA are stable over time?

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Rheumatology (2011) 50 (2): 248-249.

Which elements of the criteria for RA are stable over time?

Leendert A. Trouw1 and Tom W. J. Huizinga1

1Department of Rheumatology, C1-R, Leiden University Medical Center,

Leiden, The Netherlands

Accepted July 12, 2010.

Low seroconversion rate of anti-CCP2 and RF in early inflammatory arthritis

This editorial refers to ‘Lack of seroconversion of rheumatoid factor

and anti-cyclic citrullinated peptide in patients with early

inflammatory arthritis: a systematic literature review’, by Lillian

Barra et al., doi:10.1093/rheumatology/keq190, on page 311.

Early diagnosis of RA is increasingly recognized as an essential step

towards better patient care. Detection of autoantibodies such as RF

and especially ACPA have proved valuable for early identification of

patients with early arthritis at risk of developing RA [1]. The

presence of ACPA has been shown to be predictive of development of RA

[2] and associates with more severe diseases [3], suggesting a

possible pathogenic role for these autoantibodies. Functional studies

also implicate such a role as ACPA can trigger Fc receptors on

inflammatory cells [4] and can activate the complement system [5].

Data derived from mouse studies confirm the hypothesis that ACPA may

be pathogenic [6, 7]. Prediction rules and new criteria have been

developed to diagnose RA earlier [8, 9]. These prediction rules are

based on the 1987 RA criteria [10], which define a phenotype on which

most of our pathophysiological studies are based. It has now become

clear that this phenotype consists of two syndromes: ACPA-positive and

ACPA-negative disease that differ by genetic risk factors, histology,

clinical course and response to treatment [11–15]. The new criteria

are partly based on the decision to start MTX therapy, which allows

the inclusion of a much more heterogeneous phenotype [8].

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Read the full editorial here:

http://rheumatology.oxfordjournals.org/content/50/2/248.full?etoc

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