학술논문
Prognosis of Seronegative Patients in a Large Prospective Cohort of Patients with Early Inflammatory Arthritis
Document Type
Article
Author
Barra, Lillian; Pope, Janet E.; Orav, John E.; Boire, Gilles; Haraoui, Boulos; Hitchon, Carol; Keystone, Edward C.; Thorne, J. Carter; Tin, Diane; Bykerk, Vivian P.; Ahluwalia, Vandana; Akhavan, Pooneh; Arbillaga, Hector; Baron, Murray; Bell, Mary; Bensen, William; Boire, Gilles; Bykerk, Vivian; Cividino, Alf; Colmegna, Ines; Haraoui, Paul; Hitchon, Carol; Jamal, Shahin; Keystone, Ed; Kinkhoff, Alice; Kraishi, Majed; Larche, Maggie; Lyddell, Chris; Menard, Henri; Mosher, Dianne; Nair, Bindu; Norris, Erin; Penney, Chris; Pope, Janet; Rubin, Laurence; Shaw, Emily; Sutton, Evelyn; Thorne, Carter; Zummer, Michel
Source
Journal of Rheumatology; 2014, Vol. 41 Issue: 12 p2361-2369, 9p
Subject
Language
ISSN
0315162X; 14992752
Abstract
Objective.Rheumatoid factor (RF) and anticitrullinated protein antibodies (ACPA) are believed to be associated with more severe rheumatoid arthritis; however, studies in early inflammatory arthritis (EIA) have yielded conflicting results. Our study determined the prognosis of baseline ACPA-negative and RF-negative patients.Methods.Patients enrolled in the Canadian Early Arthritis Cohort had IgM RF and IgG anticyclic citrullinated peptide antibodies 2 (anti-CCP2) measured at baseline. Remission was defined as a Disease Activity Score of 28 joints (DAS28) < 2.6 using logistic regression accounting for confounders at 12-month and 24-month followup.Results.Of the 841 patients, 216 (26%) were negative for both RF and anti-CCP2. Compared to seropositive subjects, seronegative subjects were older (57 ± 15 vs 51 ± 14 yrs), more males proportionately (31% vs 23%), and had shorter length of symptoms (166 ± 87 vs 192 ± 98 days), and at baseline had higher mean swollen joint count (SJC; 8.8 ± 6.8 vs 6.5 ± 5.6), DAS28 (5.0 ± 1.6 vs 4.8 ± 1.5), and erosive disease (32% vs 24%, p < 0.05). Treatment was similar between the 2 groups. At 24-month followup, seronegative compared to seropositive subjects had greater mean change (Δ ± SD) in disease activity measures: ΔSJC counts (−6.9 ± 7.0 vs −5.1 ± 5.9), ΔDAS28 (−2.4 ± 2.0 vs −1.8 ± 1.8), and ΔC-reactive protein (−11.0 ± 17.9 vs −6.4 ± 17.5, p < 0.05). Accounting for confounders, antibody status was not significantly associated with remission. However, at 12-month followup, ACPA-positive subjects were independently more likely to have new erosive disease (OR 2.94, 95% CI 1.45–5.94).Conclusion.Although seronegative subjects with EIA have higher baseline DAS28 compared to seropositive subjects, they have a good response to treatment and are less likely to develop erosive disease during followup.