The relationship between the presence of anti-cyclic citrullinated peptide antibodies and clinical phenotype in very early rheumatoid arthritis

Abstract

Background: Anti-cyclic citrullinated peptide (anti-CCP) antibodies are highly specific for RA, but are not detectable in all RA patients. The aim of this study was to establish whether the clinical phenotypes of anti-CCP positive and negative disease are distinct at the earliest clinically apparent phase of disease.

Methods: Patients were recruited from the Birmingham early inflammatory arthritis clinic. Participants were included in the current study if they presented within 3 months of symptom onset and fulfilled 1987 ACR criteria for RA at some point during an 18 month follow-up. Data were collected on demographic variables, joint symptoms and tender (n = 68) and swollen (n = 66) joint counts. CRP, ESR, rheumatoid factor and anti-CCP2 status were measured.

Results: 92 patients were included (48 anti-CCP positive). The anti-CCP positive and negative groups were comparable in terms of demographic variables, inflammatory markers, joint counts and 1987 ACR classification criteria, except that more anti-CCP positive patients were rheumatoid factor positive (83.3% vs. 11.4%, p < 0.01). There was no significant difference in the pattern of joint involvement, except for an increased prevalence of knee joint swelling in anti-CCP positive patients (42.9% vs. 22.2%, p = 0.03).

Conclusions: Patients with and without anti-CCP antibodies present in a similar way, even within three months of clinically apparent disease that eventually develops into RA.

Figure 1

Cumulative proportion of patients fulfilling 1987 ACR classification criteria for RA over 18 month follow-up period. Solid line = anti-CCP antibody positive patients. Dashed line = anti-CCP antibody negative patients.

Figure 2

Clinically apparent synovial swelling in individuals with and without anti-CCP antibody. Joint involvement expressed as a percentage of the patients seen in clinic, with 95% confidence intervals. Black bars = anti-CCP antibody positive patients. White bars = anti-CCP antibody negative patients. MCP = metacarpophalangeal; PIP = proximal interphalangeal; MTP = metatarsophalangeal.