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De Rycke et al pointed out the interesting discord between rheumatoid factor titre and the titre of anti-cyclic citrullinated peptide (anti-CCP) antibodies in their patients responding to infliximab plus methotrexate treatment.1
We have looked at 158 patients receiving either infliximab or etanercept plus methotrexate and treated for a slightly longer period over 1 year, all of whom, by definition, had responded with at least an ACR20, and in whom pretreatment serum samples were available.
We found essentially the same result for anti-CCP antibodies. Twenty four (15%) serum samples were negative at the outset, one of these became strongly positive in the serum specimen after 1 year. Of those who were strongly positive, one became negative; otherwise the titres remained relatively stable. Whether this in any way reflects the observation that the extra-articular features of rheumatoid arthritis—nodules, pulmonary disease, etc—do not seem to respond to these therapeutic agents might be a suggestion worth considering.