Key result
Baseline anti-CCP positivity in early rheumatoid arthritis was associated with higher 3-year radiographic joint damage (Larsen score 5.4 vs 3.5, P=0.039) but not with disease activity.
Why the study?
Given new therapeutic options and the impact of ACPA status on early rheumatoid arthritis care, the authors evaluated whether anti-CCP remains a predictor of disease activity and radiographic joint damage in recent real-world cohorts.
Does baseline anti-CCP positivity predict disease activity and radiographic joint damage in early rheumatoid arthritis?
Observational (n=1,460)
Yes
Does baseline anti-CCP positivity predict disease activity and radiographic joint damage in early rheumatoid arthritis?
Absolute Event Rate: 5.4% vs 3.5%
p-value: p=0.039
In recent early rheumatoid arthritis cohorts, baseline anti-CCP positivity predicts increased radiographic damage but not disease activity, suggesting a need for close radiographic monitoring regardless of clinical symptoms.
May warrant closer radiographic monitoring in anti-CCP-positive early RA despite similar activity; leaves open impact on treatment decisions.
Objective: The discovery of anti-citrullinated protein antibodies (ACPAs) and the introduction of new therapeutic options have had profound impacts on early rheumatoid arthritis (RA) care. Since ACPA status, most widely assessed as reactivity to cyclic citrullinated peptides (CCPs), influences treatment decisions in early RA, we aimed to determine whether anti-CCP remains a predictor of disease activity and radiographic joint damage in more recent ‘real-world’ early RA.Method: Two observational early RA cohorts from Sweden enrolled patients in 1996–1999 (TIRA-1, n = 239) and 2006–2009 (TIRA-2, n = 444). Clinical and radiographic data and ongoing treatment were prospectively collected up to 3 years. Two other cohorts served as confirmation cohorts (TRAM-1, with enrolment 1996–2000, n = 249; and TRAM-2, 2006–2011, n = 528). Baseline anti-CCP status was related to disease activity, pharmacotherapy, and radiographic joint damage according to Larsen score.Results: In the TIRA-1 cohort, anti-CCP-positive patients had significantly higher 28-joint Disease Activity Score, swollen joint count, C-reactive protein level, and erythrocyte sedimentation rate during follow-up compared with anti-CCP-negative patients. In TIRA-2, no such differences were found, but baseline anti-CCP positivity was associated with higher 3 year Larsen score (5.4 vs 3.5, p = 0.039). In TRAM-2, anti-CCP also predicted radiographic damage (8.9 vs 6.7, p = 0.027), with no significant differences in disease activity.Conclusion: In the early RA cohorts recruiting patients in 2006–2011, baseline anti-CCP positivity was not associated with disease activity over time, but was associated with increased radiographic damage at follow-up. Hence, close radiographic monitoring is warranted in early anti-CCP-positive RA regardless of disease activity.
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Ziegelasch et al. (2020) conducted an observational in early rheumatoid arthritis (n=1,460). Baseline anti-CCP positivity vs. anti-CCP negativity was evaluated on 3 year Larsen score (radiographic joint damage) (p=0.039). Baseline anti-CCP positivity in early rheumatoid arthritis was associated with higher 3-year radiographic joint damage (Larsen score 5.4 vs 3.5, P=0.039) but not with disease activity.
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