The significance of antibodies to cyclic citrullinated peptide, antikeratin antibodies, anti-perinuclear factor, rheumatoid factor isotypes and HLA shared epitope in prediction of erosive disease in early rheumatoid arthritis patients
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KeywordsRheumatoid Arthritis Rheumatoid Factor Early Rheumatoid Arthritis Rheumatoid Arthritis Group Erosive Disease
To evaluate a predictive value of autoantibody examinations in development of erosive disease in early rheumatoid arthritis (RA).
Patients and methods
One hundred and fourteen patients with disease duration less than 2 years after the onset of symptoms were investigated. Only patients who fulfilled the diagnostic criteria for RA either at the beginning of the disease or during the follow-up period were included. The antibodies to cyclic citrullinated peptide (anti-CCP) (Immunoscan RA, Euro-diagnostica, The Netherlands), IgM, IgA and IgG rheumatoid factors (RF) were measured by ELISA, antikeratin antibodies (AKA) and antiperinuclear factor (APF) were detected by indirect immunofluorescence, and the presence of HLA shared epitope (HLA SE) was detected by PCR with sequence specific primers. Patients were divided into two groups, either with erosive or non-erosive changes present on the hand or/and feet radiographs at the end of 24 months follow-up.
Seventy-six (66.7%) patients developed bony erosion, whereas 38 (33.3%) remained without destructive changes. The initial anti-CCP, AKA, APF, IgM RF, IgA RF, IgG RF and HLA SE were positive in 50 %, 46 %, 42%, 54%, 47%, 43% and 67 % in erosive group, and in 19%, 14%, 22%, 30%, 27%, 24% and 65% in non-erosive group, respectively. The significant differences between erosive and non-erosive groups were detected for anti-CCP, AKA, IgM RF and IgA RF. The levels of anti-CCP were significantly higher in erosive early RA group (159.1 ± 224.0 units) vs. non-erosive one (85.8 ± 164.8). Similarly, patients with erosive disease had significantly higher levels of IgM RF, IgA RF and IgG RF (3,1 ± 2.8; 2.8 ± 2.6; 2.8 ± 2.6) in comparison with patients without erosions (1.9 ± 2.0; 1.8 ± 2.6; 2.1 ± 2.8).
The data showed that a measurement of anti-CCP, individual isotypes of RFs and to a less extent AKA, could be useful for prediction of disease development in the early cases of RA.