title: Association of anti-cyclic citrullinated peptide antibodies with clinical and radiological disease severity in rheumatoid arthritis.
abstract: OBJECTIVE
  This study assessed an association of anti-cyclic citrullinated peptide antibodies (ACPA) with clinical and radiological disease severity in patients with rheumatoid arthritis (RA).
  
  
  METHODS
  Fifty patients diagnosed with RA as per 2010 revised American College of Rheumatology/ European League Against Rheumatism (ACR/EULAR) classification criteria were included in this cross-sectional study. Serum levels of ACPA, C-reactive protein (CRP) and rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), disease activity score with 28-joint counts and ESR (DAS28-ESR), patient's global assessment of disease activity using visual analogue scale (PtGA-VAS), modified health assessment questionnaire score (M-HAQ) and radiological damage in hands and feet (modified Larsen score) were determined.
  
  
  RESULTS
  ACPA were positive in 48 (96%) and RF in 44 (88%) patients. Mean Larsen score was 19.82 ± 17.11 and mean DAS28-ESR 6.39 ± 1.59. A significant correlation of ACPA levels was seen with RF (p=0.03) and Larsen score (p=0.02) but not with DAS28-ESR (p=0.17) and M-HAQ (p=0.81). A significant correlation was seen between Larsen score and disease duration (p<0.0001), age (p=0.04), DAS28-ESR (p=0.001) and M-HAQ (p<0.0001). Multivariate analysis showed that painful joint count (p=0.003), ESR (p<0.001) and PtGA-VAS (p=0.009) were independently associated with clinical disease activity severity. Disease duration (p=0.01), ACPA levels (p=0.004) and DAS28-ESR (p=0.03) were independently associated with radiological joint damage.
  
  
  CONCLUSIONS
  Serum ACPA levels correlate significantly with radiological severity of RA but not with clinical disease severity and are independently associated with radiological outcome.
authors.forename: Ankit
authors.initials: A
authors.lastname: Gupta
authors.forename: Reshma
authors.initials: R
authors.lastname: Kaushik
authors.forename: Rajeev M
authors.initials: RM
authors.lastname: Kaushik
authors.forename: Manju
authors.initials: M
authors.lastname: Saini
authors.affiliation: Department of Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, India. rmkaushik1@gmail.com.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Kakkar
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000097:blood* / Q000000981:diagnostic imaging; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis*; D003430:Cross-Sectional Studies; D005260:Female; D005384:Finger Joint / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D010456:Peptides, Cyclic / Q000097:blood*; D011859:Radiography; D012217:Rheumatoid Factor / Q000097:blood*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014033:Toe Joint / Q000000981:diagnostic imaging; D055815:Young Adult
chemical_list: D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide; D002097:C-Reactive Protein; D012217:Rheumatoid Factor