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Decrease of anti-cyclic citrullinated peptide antibodies and rheumatoid factor following anti-TNF therapy (infliximab) in rheumatoid arthritis is associated with clinical improvement

C Alessandri¹, M Bombardieri¹, N Papa², M Cinquini³, L Magrini¹, A Tincani³, G Valesini¹

¹ Cattedra di Reumatologia, Dipartimento di Clinica e Terapia Medica Applicata, Università "La Sapienza", Rome, Italy
² Dipartimento di Reumatologia, Istituto Ortopedico G Pini, Milan, Italy
³ Servizio di Immunologia Clinica e Reumatologia, Ospedali Civili, Brescia, Italy

Correspondence to:
Correspondence to:
Professor G Valesini
Dipartimento di Clinica e Terapia Medica Applicata, Cattedra di Reumatologia, Università "La Sapienza", V’le del Policlinico 155, 00161 Rome, Italy; guido.valesini{at}uniroma1.it

Objective: To investigate the effect of infliximab treatment on anti-cyclic citrullinated peptide antibodies (anti-CCP) and rheumatoid factor (RF) in patients with rheumatoid arthritis.

Methods: 43 patients with rheumatoid arthritis not responding to disease modifying anti-rheumatic drugs (DMARD) received intravenous infliximab at a dose of 3 mg/kg at baseline and after two and six weeks, and subsequently bimonthly, in combination with methotrexate. Serum samples were collected at baseline and at week 24. A commercial enzyme linked immunosorbent assay was used to test for anti-CCP antibodies; RF were detected using a quantitative nephelometric assay.

Results: At baseline, 38 of the 43 patients (88%) were positive for anti-CCP antibodies, and 41 (95%) were positive for RF. The serum titre of anti-CCP and RF decreased significantly after six months of treatment (p = 0.0001 and p<0.0001, respectively). When the patients were grouped on the basis of their clinical response to infliximab, a significant decrease in serum anti-CCP antibodies and RF was observed only in patients who had clinical improvement (ACR 20 and ACR 50).

Conclusions: Anti-TNF treatment in rheumatoid arthritis results in a decrease in the serum titres of RF and anti-CCP antibodies in patients showing clinical improvement, suggesting that these measurements may be a useful adjunct in assessing treatment efficacy.

Abbreviations: ACR, American College of Rheumatology; CCP, cyclic citrullinated peptide; DMARD, disease modifying antirheumatic drug; HCV, hepatitis C virus; RF, rheumatoid factor

Keywords: anti-CCP antibodies; rheumatoid factor; rheumatoid arthritis; infliximab

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