title: Anti-citrullinated peptide antibodies and the progression of radiographic joint erosions in patients with early rheumatoid arthritis treated with FIN-RACo combination and single disease-modifying antirheumatic drug strategies.
abstract: OBJECTIVE
  To evaluate the impact of antibodies to cyclic citrullinated peptide (ACPAs) on radiographic progression in patients with early rheumatoid arthritis (RA) initially treated either with a combination of 3 disease-modifying antirheumatic drugs (DMARDs) or with a single DMARD.
  
  
  METHODS
  This study included 129 patients with early active RA initially randomised to treatment either with a combination of methotrexate, sulfasalazine, hydroxychloroquine, and prednisolone (FIN-RACo) (n=69) or with a single DMARD (initially sulfalasalazine) with or without prednisolone (SINGLE) (n=60). After 2 years, the use of DMARDs and prednisolone became unrestricted. Radiographic progression in hands and feet was assessed at baseline and at 1, 2, 3, 4 and 5 years. ACPAs at baseline were determined with enzyme immunoassay.
  
  
  RESULTS
  ACPAs were positive in 92 (71%) patients. ACPA-positive vs. negative patients were more frequently rheumatoid factor (RF) positive (83% vs. 22%, p<0.001) and had an erosive disease (54% vs. 22%, p<0.001) at baseline. The presence of ACPA was associated with radiographic progression in FIN-RACo group even when the impact of RF was controlled; the radiographic progression was remarkably slower in ACPA-negative than in ACPA-positive cases (RF adjusted change over time between groups p=0.034). In the SINGLE group, the radiographic changes progressed parallel in ACPA-negative and positive patients.
  
  
  CONCLUSIONS
  Most ACPA-positive RA patients have joint erosions already at diagnosis. ACPA positivity in early RA was related to radiographic progression even in patients treated initially with the FIN-RACo regimen. The initial FIN-RACo therapy seems to slow down the progression of joint damage in ACPA-negative patients.
authors.affiliation: Centre for Laboratory Medicine, Pirkanmaa Hospital District, Tampere, Finland. anu.mustila@pshp.fi
authors.forename: A
authors.initials: A
authors.lastname: Mustila
authors.forename: M
authors.initials: M
authors.lastname: Korpela
authors.forename: A-M
authors.initials: AM
authors.lastname: Haapala
authors.forename: H
authors.initials: H
authors.lastname: Kautiainen
authors.forename: L
authors.initials: L
authors.lastname: Laasonen
authors.forename: T
authors.initials: T
authors.lastname: Möttönen
authors.forename: M
authors.initials: M
authors.lastname: Leirisalo-Repo
authors.forename: J
authors.initials: J
authors.lastname: Ilonen
authors.forename: S
authors.initials: S
authors.lastname: Järvenpää
authors.forename: R
authors.initials: R
authors.lastname: Luukkainen
authors.forename: P
authors.initials: P
authors.lastname: Hannonen
mesh_terms: D000328:Adult; D000888:Antibodies, Anti-Idiotypic / Q000097:blood*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000276:immunology*; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D033023:Foot Joints / Q000000981:diagnostic imaging; D050823:Hand Joints / Q000000981:diagnostic imaging; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D010456:Peptides, Cyclic / Q000276:immunology*; D011239:Prednisolone / Q000627:therapeutic use*; D011859:Radiography; D012460:Sulfasalazine / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000888:Antibodies, Anti-Idiotypic; D018501:Antirheumatic Agents; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide; D012460:Sulfasalazine; D006886:Hydroxychloroquine; D011239:Prednisolone; D008727:Methotrexate