Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

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


Anti-CCP Antibodies, Rheumatoid Factor and Differences in Clinical Presentation of Early Arthritis: Results From the ESPOIR Cohort

Mouterde1,  Gaël, Rincheval2,  Nathalie, Lukas1,  Cedric, Flipo3,  RM, Goupille4,  Philippe, Daures2,  Jean-Pierre, Combe1,  Bernard

Lapeyronie hospital, Montpellier, France
Epidemiology unit, Montpellier, France
Rheumatology, Lille University, Lille
Université François Rabelais de Tours, CNRS, UMR 6239; CHRU de Tours, Tours, France

Purpose:

To compare initial clinical, biological and radiological features of early arthritis patients depending on their positivity for rheumatoid factor (RF) and/or anti-CCP antibodies (anti-CCP). To valid a patient profile based on these serological data.

Method:

Patients presenting with synovitis of at least 2 joints for 6 weeks to 6 months were included in the multicenter French ESPOIR cohort. They were tested for IgM RF (Elisa, Ménarini, France; positive if > 9 UI/ml) and Anti-CCP2 antibodies (Elisa, DiaSorin, France; positive if > 50 U/ml) and divided into 4 groups: RF- and anti-CCP-, RF+ and anti-CCP-, RF- and anti-CCP+, RF+ and anti-CCP+. The following data were collected at baseline: clinical features, C-reactive protein, erythrocyte sedimentation rate (ESR), radiographs of hands, wrists, and feet (scored according to modified Sharp score). Quantitative variables were compared across the 4 groups by using Kruskal Wallis test, and the aggregate groups were compared using a Newman-Keuls like method. Khi2 test was performed for qualitative variables across the 4 groups, and recalculated with significant variables in order to constitute new poolings of interest.

Results:

The 813 recruited patients had the following features: age 48±13 years, females: 77%, mean disease duration 103+/-52 days, DAS28 5.11±1.3, HAQ score 0.98±0.7, CRP 22.1±33.6 mg/l, HLA-DRB1*01 or 04 genes 57.6%. 406 (50%) were negative for both auto-antibodies (group 1), 91 (11.2%) were RF+ and anti-CCP- (group 2), 34 (4.1%) were RF- and anti-CCP+ (group 3), and 281 (34.6%) were positive for both auto-antibodies (group 4). Mean baseline ESR was higher in anti-CCP+ patients (group 3 and 4) (p<0.0001) and van der Heijde modified total Sharp score was higher in group 4 compared with the 3 other groups (p=0.0018). Clinical presentation did not show major informative correlation with serological profile. Group 2 and 4 (RF+ groups) had more frequent arthritis of second and third metacarpophalangeal and interphalangeal joints (p<0.0001). Group 4 (anti-CCP+ and RF+) had more frequent arthritis of 3 or more joints (p=0.001), fulfilled more frequently ACR criteria for RA (p<0.0001) compared with the 3 other groups. Group 1 (anti-CCP- and RF-) had less often positive squeeze test on metatarsophalangeal joints (p<0.0001), and arthritis of hand joints (p<0.0001). There were no differences in morning stiffness, DAS28 and HAQ score across the groups.

Conclusion:

The phenotype of early arthritis patients with or without anti-CCP and/or RF was similar with respect to clinical presentation. However at baseline, mean ESR was higher in anti-CCP groups and radiographic damage was more severe in patients with both anti-CCP and RF, suggesting that these auto antibodies may be associated with the inflammatory process and progressive disease in patients with early arthritis.

To cite this abstract, please use the following information:
Mouterde, Gaël, Rincheval, Nathalie, Lukas, Cedric, Flipo, RM, Goupille, Philippe, Daures, Jean-Pierre, et al; Anti-CCP Antibodies, Rheumatoid Factor and Differences in Clinical Presentation of Early Arthritis: Results From the ESPOIR Cohort [abstract]. Arthritis Rheum 2009;60 Suppl 10 :333
DOI: 10.1002/art.25416

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