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Decreases in rheumatoid factor (IgM-RF) during antirheumatic treatment are often reported,1 2 3 4 but the course of anti-cyclic citrullinated peptide (anti-CCP) is less conclusive, with some studies showing decrease,2 5 6 but others finding no change.4 7 8
As anti-CCP antibodies are very specific as a marker for rheumatoid arthritis (RA), decreases in anti-CCP levels on therapy may have prognostic relevance and guide further treatment decisions in patients with early RA.
A total of 21 patients with active, early RA were treated for 40 weeks with intensive conventional disease-modifying antirheumatic drug (DMARD) therapy, comprising hydroxychloroquine, sulfasalazine, methotrexate and tapered high-dose prednisolone (enhanced “COBRA” (Combinatietherapie Bij Reumatoide Artritis trial) schedule, fig 1). On non-response at 8 weeks, methotrexate (MTX)was intensified to 25 mg/week; on non-response at 21 weeks, infliximab was offered to patients on high-dose MTX and MTX was intensified in the remainder. Serum was available for 18 out of 21 patients.