Anti-cyclic citrullinated peptide antibody in rheumatoid arthritis: relation with disease aggressiveness.
OBJECTIVE
To analyse the value of the anti-cyclic citrullinated peptide antibody (anti-CCP) in patients with rheumatoid arthritis (RA) as a prognostic factor, as well as its relationship with disease activity.


METHODS
A cross-sectional study was made on 89 patients with RA. The following values were assessed: erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), anti-CCP, Disease Activity Score 28 (DAS 28), Modified Health Assessment Questionnaire score (M-HAQ) and simplified radiologic score of Sharp/Van der Heijde (SENS: simple erosion narrowing score).


RESULTS
Sixty-four percent of the patients were anti-CCP positive, from which 36.8% were negative for RF. Among negative RF patients, 48.3% had anti-CCP antibody. The average value of DAS 28 in anti-CCP positive patients was 4.31 (SD 1.27) compared to 3.30 (SD 1.55) for anti-CCP negative (p <or=0.001). There was a significant correlation between anti-CCP levels and CRP value (p <or= 0.011). 78.9% of anti-CCP positive patients presented erosions as opposed to a 53.1% of those with negative anti-CCP (p <or= 0.011), OR 3.3 (95% CI: 1.3-8.5). SENS in anti-CCP positive patients was significantly greater than in anti-CCP negative patients, 22.6 (SD 20.7) versus 13.88 (SD 19.24) (p <or= 0.054). Patients with high levels of anti-CCP (> 200 U/ml) had higher SENS (p < 0.05). There was no correlation between M-HAQ and anti-CCP.


CONCLUSIONS
Prevalence of anti-CCP was higher among patients with higher activity. Patients with higher levels of anti-CCP antibody had more aggressive disease, with greater activity (elevated values in DAS 28 and CRP) and more severe radiological damage (more erosions and higher radiological damage, SENS).
del Val del Amo
N
N
Rheumatology Department, Navarra Hospital, Pamplona, Spain. ndelvaldelamo@hotmail.com
Ibanez Bosch
R
R
Fito Manteca
C
C
Gutierrez Polo
R
R
Loza Cortina
E
E
D001172:Arthritis, Rheumatoid / Q000276:immunology / Q000473:pathology / Q000503:physiopathology; D001175:Arthrography; D001323:Autoantibodies / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006801:Humans; D007596:Joints / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010456:Peptides, Cyclic / Q000276:immunology*; D011379:Prognosis; D012217:Rheumatoid Factor / Q000097:blood; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
D001323:Autoantibodies; D015415:Biomarkers; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide; D002097:C-Reactive Protein; D012217:Rheumatoid Factor