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Prognostic laboratory markers of joint damage in rheumatoid arthritis
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  1. E Lindqvist1,
  2. K Eberhardt1,
  3. K Bendtzen2,
  4. D Heinegård3,
  5. T Saxne1
  1. 1Department of Rheumatology, Lund University Hospital, Lund, Sweden
  2. 2Institute for Inflammation Research, Rigshospitalet National University Hospital, Copenhagen, Denmark
  3. 3Department of Cell and Molecular Biology, Section for Connective Tissue Biology, Lund University
  1. Correspondence to:
    Dr Elisabet Lindqvist
    Department of Rheumatology, Lund University Hospital, S-221 85 Lund, Sweden; elisabet.lindqvistreum.lu.se

Abstract

Objective: To investigate whether determination of a set of laboratory markers at baseline provides prognostic information on joint damage in hands and feet in rheumatoid arthritis.

Methods: 183 patients with early rheumatoid arthritis included in a prospective study were examined. Radiographic changes in hands and feet at 5 and 10 years after inclusion were evaluated (Larsen). The markers analysed were: erythrocyte sedimentation rate (ESR); HLA-DRB alleles typed by restriction fragment length polymorphism; and C reactive protein, cartilage oligomeric matrix protein (COMP), rheumatoid factor (RF) (IgG, IgA, and IgM subtypes), antibodies against cyclic citrullinated peptide (anti-CCP), and antibodies against interleukin 1α (anti-IL1α), analysed by immunoassays. Multiple linear regression with backward elimination was used to determine the prognostic value of the variables.

Results: 117/176 patients were positive for IgG RF, 138/176 for IgA RF, 139/176 for IgM RF, 140/176 for anti-CCP, and 40/182 for anti-IL1α. After five years, ESR, the presence of IgA RF, serum COMP, and the presence of anti-CCP were significantly associated with more severe joint damage, and the presence of anti-IL1α with less severe joint damage. Baseline C reactive protein and anti-CCP predicted radiographic outcome after 10 years. A stronger prediction was obtained by combining the prognostic factors.

Conclusions: Early determination of anti-CCP, IgA RF, anti-IL-1α, ESR, C reactive protein, and COMP predicted the development of joint damage in hands and feet in this cohort. A combination of these measures reflecting different aspects of the disease process should be useful for evaluating prognosis in individual patients with early rheumatoid arthritis.

  • anti-CCP, antibodies against cyclic citrullinated peptide
  • COMP, cartilage oligomeric matrix protein
  • DMARD, disease modifying antirheumatic drug
  • IL1α, interleukin 1α
  • RF, rheumatoid factor
  • cyclic citrullinated peptide
  • cartilage oligomeric matrix protein
  • rheumatoid arthritis
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