Antineutrophil cytoplasmic antibodies in patients with early rheumatoid arthritis - An early marker of progressive erosive disease

Objective. To evaluate the clinical associations of antineutrophil cytoplas mic antibodies (ANCA) in patients with early rheumatoid arthritis (RA), as well as the possible predictive role of ANCA, We also assessed the overlap of ANCA with other specific serologic markers of RA. Methods. Eighty-two RA patients with symptoms for less than or equal to 12 months were studied for the presence of ANCA by immunofluorescence and spec ific enzyme immunoassays. ANCA were determined and clinical, radiographic, and laboratory data were collected at study entry and later at 12, 36, 60, and 84 months. Results. In 2 patients, the first serum samples (obtained at study entry) w ere no longer available for the determination of ANCA, Perinuclear ANCA (pA NCA) were found in 40 patients (50%), and atypical cytoplasmic ANCA were fo und in 3 patients (4%) at study entry. Perinuclear ANCA-positive patients w ere significantly more frequently positive for rheumatoid factor (78%) than were ANCA-negative patients (54%) (P = 0.0297). Fifty-five percent of pANC A-positive patients and 22% of ANCA-negative patients were positive for ant iperinuclear factor (P = 0.0044). Similarly, pANCA-positive patients had an tikeratin antibodies more frequently than did ANCA-negative patients (35% v ersus 20%). During a 7-year followup, the progress of radiographic joint de struction, assessed with Larsen scores was significantly more rapid in pati ents who were pANCA positive at study entry than in those who were ANCA neg ative (P = 0.0015), Also, the mean titer of pANCA at study entry was signif icantly higher in those patients who subsequently had advanced radiographic joint destruction at 60 and 84 months. The association of pANCA,vith rapid radiographic destruction in patients with early RA was further corroborate d by a logistic regression analysis that selected pANCA positivity as an in dependent and statistically significant predictor of rapid radiographic joi nt destruction. Conclusion. In patients with early RA, pANCA are associated with specific s erologic markers of RA and predict rapid radiographic joint destruction.