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FRI0122 Predicting factors for disappearance of anti-mutated citrullinated vimentin antibodies in sera from patients with rheumatoid arthritis
  1. N Ishigooka1,
  2. T Fujii1,2,
  3. S Kondo-Ishikawa1,
  4. M Hashimoto3,
  5. M Furu3,
  6. M Tanaka3,
  7. H Ito4,
  8. R Nakashima1,
  9. K Murakami1,
  10. Y Imura1,
  11. H Yoshifuji1,
  12. K Ohmura1,
  13. T Mimori1
  1. 1Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of medicine, Kyoto
  2. 2Department of Rheumatology and Clinical Immunology, Wakayama Medical University, Wakayama
  3. 3Department of the Control for Rheumatic Diseases
  4. 4Department of Orthopaedic Surgery, Kyoto University Graduate School of medicine, Kyoto, Japan


Background Mutated citrullinated vimentin (MCV) is one of the important targets of anti-citrullinated protein/peptide antibodies (ACPA) and is found in synovial fluid in patients with rheumatoid arthritis (RA). Serum anti-MCV antibody (anti-MCV) titer may be better correlated with RA disease activity and radiographic progression than anti-cyclic citrullinated peptide antibody (anti-CCP) titer.

Objectives In the present study, we tried to determine the predicting factor of anti-MCV disappearance in sera from RA patients.

Methods Both anti-MCV (ORGENTEC Diagnostika, Germany) and anti-CCP (MESACUPTM-2 test CCP, MBL, Japan) in sera from 280 RA patients who met 2010 ACR/EULAR classification criteria in Kyoto University RA Management Alliance (KURAMA) cohort 2013 and 2014 were measured by ELISA. Then, we determined retrospectively the predicting factors of anti-MCV disappearance using multivariate logistic analysis.

Results In 2013 cohort, anti-MCV and anti-CCP positivities were 64.6 and 84.6%, respectively. The majority (97.8%) of anti-MCV-positive patients was also anti-CCP-positive and there was significant correlation between anti-MCV and anti-CCP titers (r=0.63, p<0.001). In 2013 baseline, there was no difference in patients' age, gender and disease duration between anti-MCV-positive (n=181, 64.6%) and -negative (n=99, 35.4%) groups. DAS28, however, was higher in anti-MCV-positive group than in -negative group (3.08±1.22 vs. 2.68±1.07, p=0.011), while anti-CCP-positive (n=237, 84.6%) and -negative (n=43,15.4%) groups had no significant difference of DAS28. Of note, whereas anti-CCP positivity rate did not change during 2013 and 2014, anti-MCV changed to positive and to negative were recognized in 20 (=7.2%) and 41 (=14.6%, disappeared group) patients. So we next compared anti-MCV disappeared and sustained-positive groups (n=140, 50.0%). There was no difference in patients' age, gender, disease duration and DAS28 in 2013. While decrease of DAS28 from 2013 to 2014 (=ΔDAS28) in disappeared group was more apparent than that in sustained-positive group (-0.58±1.1 vs. +0.02±0.34, p=0.028). Methotorexate monotherapy was rarer in disappeared group than in sustained-positive group (26.5% vs. 53.8%, p=0.015), while continuous use of biological disease modifying antirheumatic drug (bDMARD) was more frequent in disappeared than sustained-positive group (64.7% vs. 25.2%, p<0.0001). Also serum levels of KL-6, a serum marker of interstitial lung disease, were lower in disappeared than in sustained-positive group (255±146 vs. 315±183, p=0.006). To clear the most effective factor in anti-MCV disappearance, we choose variables including anti-MCV titers in baseline, KL-6 levels, ΔDAS28 and bDMARD use, and performed multivariable analysis. Analysis showed that anti-MCV titers and bDMARD use, especially TNF inhibitor (Odds Ratio =7.2, p<0.001) were observed as the predicting factors of anti-MCV disappearance. On the other hand, no predicting factor for newly anti-MCV appearance was recognized in our cohort.

Conclusions Anti-MCV, but not anti-CCP, can be disappeared in a year by continuous bDMARD use regardless of disease activity.

Disclosure of Interest None declared

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