Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.

Associations of Anti-CCP and Rheumatoid Factor Concentrations with Future Disease Activity in Rheumatoid Arthritis

Mikuls4,  T. R., Hooker11,  R.S., Reimold10,  A.M., Caplan9,  Liron, Johnson8,  Dannette S., Richards7,  J.S., Kerr6,  G.S.

University of Nebraska Medical Center, Omaha, NE
VAMC, University of Texas Southwestern Medical Center, Dallas, TX
Department of Veterans Affairs, Dallas, TX
University of Nebraska and NDB, Omaha, NE
Univ of NE Medical Ctr, Omaha, NE
U Nebraska, Omaha, NE
VA and University of Utah, Salt Lake City, UT
VAMC, Georgetown University, Washington, DC
Veterans Affairs Medical Ctr, Washington, DC
University of MS Med Ctr, Jackson, MS
Univ of CO Denver School of Med, Aurora, CO


To examine and compare associations of anti-CCP antibody (aCCP) and rheumatoid factor (RF) concentrations with future disease activity in patients with established rheumatoid arthritis (RA).


Study participants were U.S. veterans with RA (n = 855). Measures of disease activity included: 1) proportion of observation in remission, 2) remission for >= 3 consecutive months, and 3) area under the curve [AUC] for DAS28. Baseline aCCP and RF were examined dichotomously, as ordered categorical variables, and continuously. Associations of autoantibody status with disease activity outcomes were examined using multivariate regression.


Patients were predominantly men (91%) with mean (SD) age of 66 (11) years and 2.3 (1.2) years of follow-up. Most were aCCP (75%) and RF (80%) positive. Associations of aCCP and RF status with sustained remission are shown in the figure below. After multivariate adjustment for age, sex, race/ethnicity, education, disease duration, follow-up time, smoking status, comorbidity, pharmacologic interventions, and disease status (DAS28 <= 2.6 vs. DAS28 > 2.6) at enrollment, aCCP and RF concentrations (per 100 unit increments) were associated with a lower proportion of observation in remission (b=-0.004, p = 0.054 and b=-0.002, p = 0.014, respectively), and greater AUC DAS28 (b= 0.02, p = 0.05 and b= 0.01, p = 0.002, respectively). In a sub-analysis of autoantibody discordant groups, higher aCCP concentrations in aCCP+/RF- patients were associated with an increased likelihood of achieving remission (OR 1.10; 95% CI 1.00–1.20) (data not shown). In contrast, among aCCP-/RF+ patients, higher RF concentrations trended towards an inverse association with remission (OR 0.81; 95% CI 0.58–1.13) (data not shown).

Figure: Age- and sex-adjusted (Solid square) and multivariate ([cir]) ORs of aCCP and RF with the achievement of sustained remission (DAS28 <= 2.6). Shapes (Solid square and [cir]) correspond to ORs, horizontal bars represent 95% CIs. ORs and CIs for 'continuous level' correspond to 100 unit increments.


Although higher aCCP concentrations are associated with greater future disease burden in patients with established RA, these associations appear to be related to concomitant elevations in serum RF.

To cite this abstract, please use the following information:
Mikuls, T. R., Hooker, R.S., Reimold, A.M., Caplan, Liron, Johnson, Dannette S., Richards, J.S., et al; Associations of Anti-CCP and Rheumatoid Factor Concentrations with Future Disease Activity in Rheumatoid Arthritis [abstract]. Arthritis Rheum 2009;60 Suppl 10 :332
DOI: 10.1002/art.25415

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