Outcomes in recent-onset inflammatory polyarthritis differ according to initial titers, persistence over time, and specificity of the autoantibodies.
OBJECTIVE
To prospectively evaluate the predictive value of initial titers and subsequent variations of 3 rheumatoid arthritis–associated antibodies for outcomes at 30 months in patients with recent-onset polyarthritis.


METHODS
IgM rheumatoid factor (RF), anti-Sa (citrullinated vimentin) antibodies, anti– cyclic citrullinated peptide 2 (anti–CCP-2) antibodies, modified Health Assessment Questionnaire score, Disease Activity Score in 28 joints, and Sharp/van der Heijde radiologic scores were determined at baseline and at 18 and 30 months in a cohort of consecutive HLA–DR-typed treated patients with recent-onset polyarthritis aiming at remission.


RESULTS
At inclusion, 113 (44.7%), 58 (22.9%), and 97 (38.3%) of 253 recent-onset polyarthritis patients were positive for RF, anti-Sa, and anti–CCP-2, respectively; at 30 months, 85 (33.6%), 31 (12.4%), and 100 (39.5%) patients were similarly positive. A low titer of any particular antibody was associated with higher risks for seroreversion. Similar to their persistent absence, reversion of RF and anti–CCP-2 was associated with low risks for severity. Patients who acquired RF or anti–CCP-2 after inclusion trended toward a poor prognosis. Relative to RF and anti–CCP-2 antibodies, only the presence of anti-Sa at inclusion, especially at higher titers and even when it subsequently disappeared, significantly predicted more rapid radiographic damage and lower remission rates at 30 months.


CONCLUSIONS
In treated recent-onset polyarthritis, anti–CCP-2 prevalence is stable or increases slightly, whereas anti-Sa and RF frequently disappear. Subsequent reversion and conversion of RF and anti–CCP-2 blur the prognostic significance of initial RF and anti–CCP-2 positivity. Of the 3 antibodies, only anti-Sa, even if it disappears afterward, independently predicts severe outcomes.
Guzian
Marie-Caroline
MC
Centre Hospitalier Universitaire de Sherbrooke, Quebec, Canada.
Carrier
Nathalie
N
Cossette
Pierre
P
de Brum-Fernandes
Artur J
AJ
Liang
Patrick
P
Ménard
Henri-A
HA
Boire
Gilles
G
D000328:Adult; D000368:Aged; D000918:Antibody Specificity / Q000502:physiology; D001168:Arthritis / Q000276:immunology* / Q000628:therapy; D001323:Autoantibodies / Q000096:biosynthesis* / Q000097:blood; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D007249:Inflammation / Q000276:immunology / Q000628:therapy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012217:Rheumatoid Factor / Q000096:biosynthesis / Q000097:blood; D013997:Time Factors; D016896:Treatment Outcome
D001323:Autoantibodies; D007075:Immunoglobulin M; D012217:Rheumatoid Factor