The prognostic value of anti-cyclic citrullinated peptide antibody in patients with recent-onset rheumatoid arthritis

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Abstract
Objective To study the predictive value of anti–cyclic citrullinated peptide antibody (anti‐CCP) in patients with recent‐onset rheumatoid arthritis (RA). Methods Outcome in terms of physical disability (Health Assessment Questionnaire) and radiologic damage (modified Sharp method) over 3‐year and 6‐year periods was determined in an inception cohort of 273 RA patients who had had disease symptoms for >1 year at study entry. Anti‐CCP titers were determined at baseline and considered positive as recently described. Their prognostic value was studied by means of multiple regression analysis, in which anti‐CCP positivity, sex, age at study entry, IgM rheumatoid factor (IgM‐RF) status, Disease Activity Score (DAS), HLA–DR4 status, and (in a separate group of patients) shared epitope status were used as independent variables, and radiologic damage and functional disability as dependent variables. Results Patients with anti‐CCP had developed significantly more severe radiologic damage after 6 years of followup. In multiple regression analysis, radiologic damage after 6 years followup was significantly predicted by IgM‐RF status, radiologic score at entry, and anti‐CCP status. Functional disability was significantly predicted by sex, age at entry, IgM‐RF status, and DAS. Conclusion Our data show that in almost 70% of RA patients, anti‐CCP antibody is present at the early stages of disease. Anti‐CCP–positive patients developed significantly more severe radiologic damage than patients who were anti‐CCP negative, although in multiple regression analysis the additional predictive value was rather moderate.