Journal
JOURNAL OF RHEUMATOLOGY
Volume 40, Issue 8, Pages 1259-1267Publisher
J RHEUMATOL PUBL CO
DOI: 10.3899/jrheum.120736
Keywords
ANTICITRULLINATED PROTEIN ANTIBODIES; RHEUMATOID FACTOR; RHEUMATOID ARTHRITIS; EROSIONS; REMISSION
Categories
Funding
- Amgen Canada Inc.
- Pfizer Canada Inc.
- Hoffmann-La Roche Ltd.
- United Chemicals of Belgium (UCB) Canada Inc.
- Bristol-Myers Squibb Canada Co.
- Abbott Laboratories Ltd.
- Janssen Biotech Inc.
- Program of Experimental Medicine, The University of Western Ontario
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Objective. In inflammatory arthritis, rheumatoid factor (RF) and anticitrullinated protein antibodies (ACPA) are believed to be associated with more severe clinical outcomes. Our objective was to determine whether ACPA and RF remain stable in early inflammatory arthritis and whether their trajectories over time or baseline levels predicted clinical outcomes. Methods. The study population consisted of patients enrolled in the Canadian Early Arthritis Cohort Study with baseline and at least 12-month followup values of RF and ACPA. Primary outcomes were Disease Activity Score (DAS) remission and the presence of erosions at 12 and 24 months. Other objectives included swollen joint count, Health Assessment Questionnaire score, and DAS. Results. At baseline, 225/342 (66%) patients were ACPA-positive and 334/520 (64%) were RF-positive. At 24 months, 15/181 (8%) ACPA-positive patients became negative. A larger number of patients changed from ACPA-negative to positive: 13/123 (11%). For RF, fluctuations were more common: 67/240 (28%) reverted from positive to negative and 21/136 (18%) converted from negative to positive. RF and ACPA fluctuations did not predict disease outcomes. Patients who remained ACPA-positive throughout followup were more likely to have erosive disease (OR 3.86, 95% CI 1.68, 8.92). Conclusion. RF and ACPA have the potential to revert and convert during the early course of disease. Fluctuations in RF and ACPA were not associated with clinical outcomes.
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