title: Anti-cyclic citrullinated peptide antibody in rheumatoid arthritis: relation with disease aggressiveness.
abstract: 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).
authors.affiliation: Rheumatology Department, Navarra Hospital, Pamplona, Spain. ndelvaldelamo@hotmail.com
authors.forename: N
authors.initials: N
authors.lastname: del Val del Amo
authors.forename: R
authors.initials: R
authors.lastname: Ibanez Bosch
authors.forename: C
authors.initials: C
authors.lastname: Fito Manteca
authors.forename: R
authors.initials: R
authors.lastname: Gutierrez Polo
authors.forename: E
authors.initials: E
authors.lastname: Loza Cortina
mesh_terms: 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
chemical_list: D001323:Autoantibodies; D015415:Biomarkers; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide; D002097:C-Reactive Protein; D012217:Rheumatoid Factor