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The New EULAR/ACR Classification ACPA Cutoff Levels Are Markers of Poor Radiological Outcome in Early Rheumatoid Arthritis

AuthorsGómez-Puerta, José A.; Ruiz-Esquide, V.; Hernández, M. V.; Graell, Eduard; Cabrera, Sonia; Gómara Elena, María José ; Cañete, Juan D.; Haro Villar, Isabel ; Sanmartí, Raimon
KeywordsAnti-CCP antibodies
Outcome measures
Radiography and rheumatoid arthritis (RA)
Issue Date2011
CitationArthritis and Rheumatism
AbstractBackground/Purpose: The recent proposed EULAR/ACR criteria for rheumatoid arthritis (RA) were established in part as a useful tool for identify and classified patients with early RA. The cutoff level of 3 times upper limit of normal (ULN) for ACPA antibodies have been pondered as an additional criteria item. Its value as prognostic marker in terms of radiological progression has not been established yet. Aim: To analyzed the relation of high titers levels of ACPA according to EULAR/ACR criteria with radiological progression in a cohort of patients with early RA. Method: We conducted a prospective open-label study that included early RA patients from 2 referral centers. All patients were treated with a similar therapeutic protocol with DMARD. ACPA antibodies were determined by a second-generation anti-CCP2 ELISA test (Eurodiagnostica). We classified 3 populations according to ACPA titers: negative (<29 IU, using own cutoff), positive at low titers (< 3 times ULN) and positive at high titers (> 3 ULN). Additionally, positive ACPA patients were divided as low positive or high positive using median values (293 IU). The minimal clinically-important difference (MCID) was used as a measure of Larsen radiographic progression, with a change of two or more units in the Larsen score considered as indicative of progression after one year in early RA Result: One hundred and fifty-five patients were included, 83% of female gender. The mean age was 54.7 ± 14.9 years, with a mean disease duration of 9.7 ± 6.6 months. Rheumatoid factor was positive in 76.3% and ACPA in 75.7%. At baseline Larsen score was 1.9 ± 6.9 and erosion joint count was 0.4 ± 1.3. Thirty percent of patients had Larsen score ≥1 and the18.6% had erosion joint count ≥1. At baseline, 23% of patients were negative for ACPA, 11% of patients were positive at low titers (<3 ULN) while 65% of patients had high titers of ACPA (>3 ULN). After two years of follow-up those patients classified as ACPA positive at high titers had a higher radiological progression than those patients with ACPA negative or ACPA positive at low titers (See Table). When radiological progression was analyzed according to median levels, there were no differences among ACPA positive at low titers and ACPA positive at high titers. Conclusion: After two years of follow-up, patients with early RA with high titers of ACPA according new EULAR/ACR criteria had greater radiographic progression than those patients ACPA negative or positive at low titers. ACPA titers could have not only classification utility but also prognosis implications. (> 3 ULN) Low titers 13 76 4 23 High titers 65 65 35 35 Total 108 45 0,204 ACPA Negative 30 83 6 16 (Median) (<median) 38 64 21 35 (>median) 40 68 18 31 Total 108 45
Publisher version (URL)http://www.rheumatology.org/publications/ar/index.asp
Appears in Collections:(IQAC) Artículos
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