Prediction of radiological outcome in early rheumatoid arthritis in clinical practice: role of antibodies to citrullinated peptides (anti-CCP)
- 1Section of Rheumatology, Helsingborgs lasarett, Helsingborg, Sweden
- 2Rheumatology Department, Sahlgrenska University Hospital, Mölndal, Sweden
- 3Rheumatology Department, University Hospital, Lund, Sweden
- 4Rheumatology Department, Karolinska Institutet at Huddinge University Hospital, Stockholm, Sweden
- Correspondence to:
Dr B Svensson
Blistorpsvägen 105, 290 38 Villands Vånga, Sweden;
- Accepted 17 October 2003
Objective: To investigate the role of anti-cyclic citrullinated peptide antibody (anti-CCP) for the prediction of radiological outcome in patients with early rheumatoid arthritis.
Methods: Anti-CCP was assessed at baseline in 379 patients with early rheumatoid arthritis (disease duration <1 year). Radiological joint damage and progression were assessed by Larsen score after two years of follow up (end point) and used as outcome variables. The prognostic value of anti-CCP and other demographic and disease related baseline variables were assessed by univariate and multivariate analyses, including calculation of odds ratios (OR), predictive values, and multiple logistic regression models.
Results: The presence of anti-CCP was associated with significantly higher Larsen score both at baseline and at end point. Univariate predictor analysis showed that anti-CCP had the highest significant OR for radiological joint damage and progression after baseline Larsen score, followed by rheumatoid factor, erythrocyte sedimentation rate (ESR), C reactive protein, age, smoking status, and sex. In stepwise multiple regression analyses, baseline Larsen score, anti-CCP, and ESR were selected as significant independent predictors of the radiological outcomes.
Conclusions: There is good evidence for an association of anti-CCP with radiological joint changes in rheumatoid arthritis. Anti-CCP is an independent predictor of radiological damage and progression. Though prediction in early rheumatoid arthritis is still far from perfect, the use of anti-CCP in clinical practice should make it easier for rheumatologists to reach judicious treatment decisions.
- AKA, antikeratin antibody
- AFA, antifilaggrin antibody
- APF, antiperinuclear factor
- BARFOT, better anti-rheumatic farmacotherapy study
- CCP, cyclic citrullinated peptides
- DAS, disease activity score
- DMARD, disease modifying antirheumatic drug
- HAQ, health assessment questionnaire
- ICC, intraclass correlation coefficient
- NPV, negative predictive value
- PPV, positive predictive value
- RF, rheumatoid factor
- VAS, visual analogue scale