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. 2018 Jan 30;20(1):16.
doi: 10.1186/s13075-018-1515-1.

Anti-CCP-positive patients with RA have a higher 10-year probability of fracture evaluated by FRAX®: a registry study of RA with osteoporosis/fracture

Tien-Tsai Cheng  1   2 , Shan-Fu Yu  3   4 , Fu-Mei Su  3 , Yin-Chou Chen  3   4 , Ben Yu-Jih Su  3   4 , Wen-Chan Chiu  3 , Chung-Yuan Hsu  3 , Jia-Feng Chen  3 , Chi-Hua Ko  3 , Han-Ming Lai  5
Affiliations

Anti-CCP-positive patients with RA have a higher 10-year probability of fracture evaluated by FRAX®: a registry study of RA with osteoporosis/fracture

Tien-Tsai Cheng et al. Arthritis Res Ther. .

Abstract

Background: Positive anticyclic citrullinated peptide (anti-CCP+) is associated with bone loss in patients with rheumatoid arthritis (RA). However, whether overall positivity or specific levels of anti-CCP are associated with prevalent fracture or a 10-year probability of fracture remains unclear.

Methods: This interim analysis of an RA registry was conducted at Chang Gung Memorial Hospital in Kaohsiung (CGMHK) for RA-related osteoporosis/fracture. Consecutive patients with RA who had visited the rheumatology clinic at CGMHK since September 1, 2014, and fulfilled the classification criteria of RA were enrolled. The demographics, disease duration, Disease activity in 28 joints based on erythrocyte sedimentation rate (DAS28-ESR), lifestyle, evidence of previous fracture, risk factors of fracture in the Fracture Risk Assessment Tool (FRAX®), and FRAX® score of each participant were collected. Anti-CCP, rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and bone mineral density (BMD) were measured at enrollment. The patients were grouped by positivity or quartiles of anti-CCP level (I-IV).

Results: Five hundred twenty-one patients with RA were enrolled through May 31, 2016. In total, 359 (68.9%) patients were anti-CCP+. Compared with anti-CCP- patients, anti-CCP+ patients had a significantly higher DAS28-ESR (p = 0.0001) and 10-year probability of major (15.0 [18.9] vs. 12.0 [15.3], p = 0.0461) or hip (5.0 [9.2] vs. 3.6 [8.2], p = 0.0118) fracture, but a significantly lower BMD of the FN (p = 0.0196). The rates of osteoporosis and previous fracture were comparable. There were 130, 127, 132, and 132 patients in groups I-IV, respectively. The DAS28-ESR was significantly different (p = 0.0001) among the groups and correlated to anti-CCP levels. The BMD and 10-year probability of major (p = 0.0067) and hip (p = 0.0013) fracture among the groups were also different.

Conclusions: Anti-CCP+ RA patients had a higher 10-year probability of major or hip fracture, independent of anti-CCP levels, and a lower BMD of the FN than anti-CCP- patients.

Keywords: Anti-cyclic citrullinated peptide; FRAX; Rheumatoid arthritis.

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Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Regional Ethical Review Board of CGMHK (104-3530B), and the patients gave written consent according to the Declaration of Helsinki.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Association between positivity of anti-citrullinated protein antibodies (anticyclic citrullinated peptide-positive [anti-CCP+] or anti-CCP−) and systemic bone mineral density (a) or 10-year probability of fracture (b) in RA patients. FN Femoral neck
Fig. 2
Fig. 2
Bone mineral density at the spine (L1–L4) (a), hip (total) (b), and FN (c) in subgroups (I–IV) of RA patients stratified according to quartiles of anti-CCP levels. FN femoral neck
Fig. 3
Fig. 3
Ten-year probability of major (a) and hip (b) fracture in subgroups (I–IV) of RA patients stratified according to quartiles of anti-CCP levels
See this image and copyright information in PMC

Comment in

  • Anti-CCP antibodies and bone.
    Orsolini G, Viapiana O, Rossini M, Adami G, Caimmi C, Fassio A, Gatti D. Orsolini G, et al. Arthritis Res Ther. 2018 Apr 10;20(1):63. doi: 10.1186/s13075-018-1566-3. Arthritis Res Ther. 2018. PMID: 29636111 Free PMC article. No abstract available.

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