title: Long-term stability of anti-cyclic citrullinated peptide antibody status in patients with early inflammatory polyarthritis.
abstract: BACKGROUND
  The utility of reassessing anti-cyclic citrullinated peptide (anti-CCP) antibody status later in disease in patients presenting with early undifferentiated inflammatory polyarthritis, particularly in those who test negative for both anti-CCP and rheumatoid factor (RF) at baseline, remains unclear. We aimed therefore to determine the stability of CCP antibody status over time and the prognostic utility of repeated testing in subjects with early inflammatory polyarthritis (IP).
  
  
  METHODS
  Anti-CCP and RF were measured at baseline and 5 years in 640 IP patients from the Norfolk Arthritis Register, a primary care-based inception cohort. The relation between change in anti-CCP status/titer and the presence of radiologic erosions, the extent of the Larsen score, and Health Assessment Questionnaire (HAQ) score by 5 years was investigated.
  
  
  RESULTS
  With a cut-off of 5 U/ml, 28% subjects tested positive for anti-CCP antibodies, 29% for RF, and 21% for both at baseline. Nine (2%) anti-CCP-negative patients seroconverted to positive, and nine (4.6%) anti-CCP-positive individuals became negative between baseline and 5 years. In contrast, RF status changed in 17% of subjects. However, change in RF status was strongly linked to baseline anti-CCP status and was not independently associated with outcome. Ever positivity for anti-CCP antibodies by 5 years did not improve prediction of radiographic damage compared with baseline status alone (accuracy, 75% versus 74%). A higher baseline anti-CCP titer (but not change in anti-CCP titer) predicted worse radiologic damage at 5 years (P < 0.0001), even at levels below the cut-off for anti-CCP positivity. Thus, a titer of 2 to 5 U/ml was strongly associated with erosions by 5 years (odds ratio, 3.6 (1.5 to 8.3); P = 0.003).
  
  
  CONCLUSIONS
  Repeated testing of anti-CCP antibodies or RF in patients with IP does not improve prognostic value and should not be recommended in routine clinical practice.
authors.affiliation: Arthritis Research UK Epidemiology Unit, Manchester Academy of Health Sciences, The University of Manchester, Stopford Building, Oxford Road, Manchester M13 9PT, UK.
authors.forename: Marian L
authors.initials: ML
authors.lastname: Burr
authors.forename: Sebastien
authors.initials: S
authors.lastname: Viatte
authors.forename: Marwan
authors.initials: M
authors.lastname: Bukhari
authors.forename: Darren
authors.initials: D
authors.lastname: Plant
authors.forename: Deborah P
authors.initials: DP
authors.lastname: Symmons
authors.forename: Wendy
authors.initials: W
authors.lastname: Thomson
authors.forename: Anne
authors.initials: A
authors.lastname: Barton
mesh_terms: D001172:Arthritis, Rheumatoid / Q000097:blood* / Q000175:diagnosis* / Q000276:immunology; D001323:Autoantibodies / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010456:Peptides, Cyclic / Q000276:immunology*; D011379:Prognosis
chemical_list: D001323:Autoantibodies; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide