Background Rheumatoid arthritis (RA) is chronic inflammatory rheumatic disease which leads to joint damage, functional impairment and a reduction in quality of life (QoL). Determination of anti-citrullinated peptide antibodies (ACPA) plays a relevant role in the diagnosis and prognosis of RA.
Objectives The aim of this study was to assess the association between the autoantibodies and disease activity, disability and QoL in the patients with established RA.
Methods A total 69 patients with established RA were studied. Demographic and clinical data were recorded. Disease activity was evaluated with the Disease Activity Score (DAS28) C-reactive protein criteria, The Simplified Disease Activity Index (SDAI) and Clinical Disease Activity Index (CDAI). Health Assessment Questionnaire (HAQ) was used for functional disability. The QoL was evaluated with Short Form-36 (SF-36).
Results 80% of the patients were taking disease-modifying anti-rheumatic drugs (DMARDs). 50 of the RA patients were positive for autoantibodies; 42 were positive for anti-CCP only, 30 were positive for both anti-CCP and RF, and 18 were positive for all three antibodies. While concomitant presence of anti-Sa and anti-CCP was determinated in 25 (36.2%), isolated positivity for anti-Sa was observed only in one patient. The mean titers of anti-CCP and RF were significantly higher in the anti-Sa positive group compared to the negative group (p<0.05). Statistically significant associations were found between presence of anti-Sa and the SF-36 variables: physical functioning (p<0.001), role-physical (p<0.01), bodily pain (p<0.05), vitality (p<0.05). Anti-CCP positive patients had worse SF-36 role-physical (p<0.05), and bodily pain (<0.05) subscores. The presence of anti-CCP antibodies was also associated with higher CRP and SDAI scores (p<0.05, p<0.05 respectively). There was no correlation between disability and presence of autoantibodies. There was also no correlation between RF positivity QoL and disability. The patients positive for all three autoantibodies had worse SF-36 physical function subcore than the patients positive for only one autoantibody or negative for all autoantibodies (p<0.01, p<0.05, respectively).
Conclusions This is the first study evaluating the relation between the ACPAs and disease activity and QoL in the Turkish patients with established RA. The presence of all three autoantibodies has been found to be related with worse QoL. Assessment of anti-Sa in addition to anti-CCP and RF may be important to assess disease prognosis and to design effective early therapeutic strategies.
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Disclosure of Interest None declared