title: Rheumatoid factor and anti-CCP do not predict progressive joint damage in patients with early rheumatoid arthritis treated with prednisolone: a randomised study.
abstract: OBJECTIVE
  To analyse if predictors of radiographic progression differ between patients treated with or without prednisolone in early rheumatoid arthritis (RA). Radiographs of hands and feet were assessed using the modified Sharp/van der Heijde score and radiographic progression was defined as an increase in the total Sharp score above 5.8 (the smallest detectable change).
  
  
  METHODS
  Prospective, randomised study of patients with early RA.
  
  
  METHODS
  Secondary level of care; six participating centres from southern Sweden; both urban and rural populations.
  
  
  METHODS
  In all, 225 patients, 64% women, with a diagnosis of RA according to the American College of Rheumatology criteria, were included if they were between 18 and 80 years of age and had a disease duration of less than 1 year.
  
  
  METHODS
  The patients were randomised to 7.5 mg prednisolone daily for 2 years (P-group; n=108) or no prednisolone (NoP-group; n=117) when they started with their first disease-modifying anti-rheumatic drug and were prospectively followed for 2 years.
  
  
  RESULTS
  The frequency of patients with radiographic progression after 2 years was 26% in the P-group and 39% in the NoP-group (p=0.033). Relevant interactions between treatment and rheumatoid factor (RF) (p=0.061) and between treatment and anti-cyclic citrullinated peptide 2 (anti-CCP) (p=0.096) were found. RF and anti-CCP independently predicted radiographic progression only in the NoP-group, OR (95% CI) 9.4 (2.5 to 35.2), p=0.001 and OR (95% CI) 8.7 (2.5 to 31.3), p=0.001, respectively.
  
  
  CONCLUSIONS
  The presence of RF and anti-CCP predicted radiographic progression in patients not treated with prednisolone but failed to predict progression in patients treated with this drug. The data suggest that early treatment with prednisolone may modulate not only inflammation but also autoimmunity-associated pathogenetic mechanisms.
  
  
  BACKGROUND
  ISRCTN20612367.
authors: Rheumatology Unit, Karolinska Institutet at Karolinska University Hospital Huddinge, Stockholm, Sweden.
authors: Ingiäld
authors: I
authors: Hafström
authors: Rheumatology Unit, Karolinska Institutet at Karolinska University Hospital Huddinge, Stockholm, Sweden.
authors: Inga-Lill
authors: IL
authors: Engvall
authors: Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
authors: Johan
authors: J
authors: Rönnelid
authors: Department of Internal Medicine, Division of Rheumatology, University Hospital, and CAPHRI Research Institute Maastricht, Maastricht, The Netherlands.
authors: Annelies
authors: A
authors: Boonen
authors: Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
authors: Désirée
authors: D
authors: van der Heijde
authors: Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
authors: Björn
authors: B
authors: Svensson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy*; D015415:Biomarkers / Q000097:blood; D018450:Disease Progression; D005260:Female; D005528:Foot / Q000000981:diagnostic imaging; D006225:Hand / Q000000981:diagnostic imaging; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010456:Peptides, Cyclic / Q000097:blood*; D011237:Predictive Value of Tests; D011239:Prednisolone / Q000627:therapeutic use*; D011446:Prospective Studies; D011859:Radiography; D012217:Rheumatoid Factor / Q000097:blood*; D013548:Sweden; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D018501:Antirheumatic Agents; D015415:Biomarkers; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide; D012217:Rheumatoid Factor; D011239:Prednisolone
keywords: Rheumatology