Background Anti-cyclic citrullinated peptide antibodies (Anti-CCP Ab) are well-established serological markers that show high sensitivity and specificity in diagnosing early rheumatoid arthritis (RA). Furthermore, Anti-CCP Ab is reported to be associated with bone erosions of RA. Therefore, Anti-CCP Ab positive RA patient can be a candidate for intensive treatment.
Objectives Upper measurement limit of Anti-CCP Ab increased recently up to 1200 units. High level of Anti-CCP Ab may be a predictor of the profound therapy for RA. To understand the importance of Anti-CCP Ab level, we evaluated RA patients with high titer Anti-CCP Ab in relationship to the other activity markers of RA and the intensity of the treatment for RA.
Methods Total of 186 RA patients with Anti-CCP Ab higher than 30 units was included in this study. Baseline markers such as CRP, MMP-3, RF and anti-CCP Ab were measured at the entry of the study. Relationship among these markers ware evaluated and examined using statistical significance for the single-factor ANOVA and the multiple comparisons. Among those cases 131 cases were treated conservatively with biologics and/or DMARDs and were followed up more than one year. We graded them from I to IV by the intensity of the treatment. Grade I: Biological agent. Grade II: Methotrexate (MTX) more than 12mg or combination with more than 3 DMARDS Grade III: MTX 6–11mg or combination with two recommended DMARDS Grade IV: single use of DMARDS including MTX less than 5mg.
Results There was no relationship between titers of Anti-CCP Ab and titers of RF. We found significant statistical correlation between anti-CCP antibody titers and inflammatory markers such as CRP and MMP-3. There was significant statistical correlation between CRP and MMP-3.
In terms of treatment intensity, strong intensity group showed high titer of anti-CCP Ab and CRP. Titer of RF and MMP-3 level did not have any relationship with the treatment intensity. In cases treated with biologics, anti-CCP Ab and CRP were significantly higher compared to non-biologic case group. In 80% of cases treated with biologics titer of anti-CCP was more than 200 units. However, non-biologic treatment was continued in more than 50% of cases with anti-CCP Ab higher than 200 units.
Conclusions Even though we treated cases based on the severity of the symptoms of the patient and response in laboratory data, high anti-CCP Ab titers and CRP at the base line were most associated with the treatment intensity after 1 year. The results of our study suggest that the titer of anti-CCP Ab can be better a predictor of the treatment intensity than MMP-3 and RF.
Disclosure of Interest None declared
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