Arthritis development in patients with arthralgia is strongly associated with anti-citrullinated protein antibody status: a prospective cohort study
Arthritis development in patients with arthralgia is strongly associated with anti-citrullinated protein antibody status: a prospective cohort study
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DOI：
10.1136/ard.2008.105759
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发表时间：
2010-03-01
影响因子：
27.4
通讯作者：
van Schaardenburg, D.
中科院分区：
文献类型：
--
作者：
Bos, W. H.;Wolbink, G. J.;van Schaardenburg, D.
目的探讨抗瓜氨酸蛋白抗体(ACPA)的存在及其水平对关节痛患者关节炎发生的影响。方法对ACPA或IgM类风湿因子(IgM-RF)阳性的关节痛患者进行共同表位(SE)检测，并进行至少12个月的前瞻性随访。两名研究人员独立证实了在纳入时没有临床关节炎和在随访期间关节炎的发展。结果147例关节痛患者中，ACPA阳性50例，IgM-RF阳性52例，两种抗体均阳性45例。平均随访28个月(四分位数范围19-39)，29例患者发生关节炎，平均4个关节(IQR 3-6)，其中26个(90%)ACPA阳性。ACPA(HR=6.0；95%可信区间(95%CI)1.8~19.8；p=0.004)和SE(HR=1.5，95%CI 0.7~3.0)与关节炎的发生无关。在ACPA阳性患者组中，IgM-RF(HR=3.0；95%CI 1.4~6.9；P=0.01)和高ACPA水平(HR=1.7；95%CI 1.1~2.5；P=0.008)的存在增加了关节炎的风险，但SE(HR=1.0；95%CI 0.5~2.1；P=1.0)不存在。同时存在IgM-RF或高水平的ACPA可能会进一步增加ACPA阳性患者的风险。
Background Anti-citrullinated protein antibodies (ACPA) are associated with increased risk for rheumatoid arthritis.Objective To investigate the effect of the presence and levels of ACPA on arthritis development in patients with arthralgia.Methods Patients with arthralgia positive for ACPA or IgM rheumatoid factor (IgM-RF) were tested for the shared epitope (SE) and were prospectively followed up for at least 12 months. Absence of clinical arthritis at inclusion and arthritis development during follow-up were independently confirmed by two investigators. Cox regression hazard analyses were used to calculate hazard ratios (HRs) for arthritis development.Results 147 patients with arthralgia were included (50 ACPA positive, 52 IgM-RF positive and 45 positive for both antibodies). After a median follow-up of 28 months (interquartile range (IQR) 19-39), 29 patients developed arthritis in a median of 4 (IQR 3-6) joints and 26 (90%) of these were ACPA positive. The presence of ACPA (HR = 6.0; 95% confidence interval (95% CI) 1.8 to 19.8; p = 0.004), but not of IgM-RF (HR = 1.4, 95% CI 0.6 to 3.1) nor the SE (HR = 1.5, 95% CI 0.7 to 3.0), was associated with arthritis development. Within the group of ACPA-positive patients, the risk for arthritis was enhanced by the presence of IgM-RF (HR = 3.0; 95% CI 1.4 to 6.9; p = 0.01) and high ACPA levels (HR = 1.7; 95% CI 1.1 to 2.5; p = 0.008), but not the SE (HR = 1.0; 95% CI 0.5 to 2.1; p = 1.0).Conclusion In patients with arthralgia the presence of ACPA (but not of IgM-RF or SE) predicts arthritis development. The risk in ACPA-positive patients may be further increased by the concomitant presence of IgM-RF or high levels of ACPA.