title: Anti-CCP status determines the power Doppler oscillation pattern in rheumatoid arthritis: a prospective study.
abstract: Rheumatoid arthritis (RA) is a chronic inflammatory disease leading to joint destruction. Serologically, it can be differentiated according to rheumatoid factor (RF), anti-cyclic citrullinated peptide antibodies (anti-CCP), or both. This differentiation is prognostically and therapeutically relevant. No method has been described to separate the two forms phenotypically. We hypothesize that a differentiation is possible by evaluating oscillation patterns in power Doppler sonography (PDS). In a prospective study, 20 patients with anti-CCP-positive RA and 20 patients with anti-CCP-negative RA with active wrist synovitis were examined. A PDS scan was performed, and perfusion maxima (Pmax) and minima (Pmin) as well as the amplitude (ΔP) were determined by a blinded study member. The amplitude was standardized (sΔP) by dividing by Pmax, and the anti-CCP-positive and anti-CCP-negative patients as well as the RF-positive and RF-negative were compared to each other. In the ultrasonographic evaluation, we found a highly significant difference in sΔP between CCPp and CCPn patients (median 19.0 vs. 42.9 %, p < 0.0001). sΔP is independent of disease activity. The absolute amplitude ΔP did not differ between the groups. Also, in anti-CCP-positive patients there was a completely linear correlation between Pmaxand Pmin, and this was far less marked in anti-CCP-negative patients. Anti-CCP-positive and anti-CCP-negative RA display different PDS oscillation patterns. This constitutes a nonserological parameter to differentiate between the two forms. The difference in PDS oscillation patterns suggests that the underlying pathological process differs between the forms.
authors: Department of Rheumatology/Immunology, Medical Clinic II, University Clinic Wuerzburg, Oberduerrbacher Str. 6, 97080, Würzburg, Germany. Gadeholt_o@ukw.de.
authors: Ottar
authors: http://orcid.org/0000-0001-6320-4818
authors: O
authors: Gadeholt
authors: Department of Experimental Radiology, University Clinic Wuerzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
authors: Tobias
authors: T
authors: Wech
authors: Department of Rheumatology/Immunology, Medical Clinic II, University Clinic Wuerzburg, Oberduerrbacher Str. 6, 97080, Würzburg, Germany.
authors: Sebastian
authors: S
authors: Schuh
authors: Department of Rheumatology/Immunology, Medical Clinic II, University Clinic Wuerzburg, Oberduerrbacher Str. 6, 97080, Würzburg, Germany.
authors: Eva
authors: E
authors: Scharbatke
authors: Department of Rheumatology/Immunology, Medical Clinic II, University Clinic Wuerzburg, Oberduerrbacher Str. 6, 97080, Würzburg, Germany.
authors: Eva
authors: E
authors: Ostermeier
authors: Department of Rheumatology/Immunology, Medical Clinic II, University Clinic Wuerzburg, Oberduerrbacher Str. 6, 97080, Würzburg, Germany.
authors: Hans-Peter
authors: HP
authors: Tony
authors: Department of Rheumatology/Immunology, Medical Clinic II, University Clinic Wuerzburg, Oberduerrbacher Str. 6, 97080, Würzburg, Germany.
authors: Marc
authors: M
authors: Schmalzing
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000000981:diagnostic imaging* / Q000276:immunology; D001323:Autoantibodies / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010456:Peptides, Cyclic / Q000276:immunology*; D011446:Prospective Studies; D018608:Ultrasonography, Doppler
chemical_list: D001323:Autoantibodies; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide
keywords: Anti-CCP; Power Doppler sonography; Rheumatoid arthritis; Rheumatoid factor; Ultrasonography