The prognostic value of anti-cyclic citrullinated peptide antibody in patients with recent-onset rheumatoid arthritis

Objective. To study the predictive value of anti-cyclic citrullinated pepti de antibody (anti-CCP) in patients with recent-onset rheumatoid arthritis ( RA). Methods. Outcome in terms of physical disability (Health Assessment Questio nnaire) and radiologic damage (modified Sharp method) over 3-year and 6-yea r periods was determined in an inception cohort of 273 RA patients who had had disease symptoms for <1 year at study entry. Anti-CCP titers were deter mined at baseline and considered positive as recently described. Their prog nostic value was studied by means of multiple regression analysis. In which anti-CCP positivity, sex, age at study entry, IgM rheumatoid factor (IgM-R F) status. Disease Activity Score (DAS), HLA-DR4 status, and (in a separate group of patients) shared epitope status were used as independent variable s, and radiologic damage and functional disability as dependent variables. Results. Patients with anti-CCP had developed significantly more severe rad iologic damage after 6 years of followup. In multiple regression analysis, radiologic damage after 6 years followup was significantly predicted by IgM -RF status, radiologic score at entry, and anti-CCP status. Functional disa bility was significantly predicted by sex, age at entry, IgM-RF status, and DAS. Conclusion. Our data show that in almost 70% of RA patients, anti-CCP antib ody is present at the early stages of disease. Anti-CCP-positive patients d eveloped significantly more severe radiologic damage than patients who were anti-CCP negative, although in multiple regression analysis the additional predictive value was rather moderate.