Missing Anticitrullinated Protein Antibody Does Not Affect Short-term Outcomes in Early Inflammatory Arthritis: From the Canadian Early Arthritis Cohort
Missing Anticitrullinated Protein Antibody Does Not Affect Short-term Outcomes in Early Inflammatory Arthritis: From the Canadian Early Arthritis Cohort
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DOI：
10.3899/jrheum.150260
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发表时间：
2015-11-01
影响因子：
3.9
通讯作者：
Pope, Janet E.
中科院分区：
文献类型：
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作者：
Shu, Jenny;Bykerk, Vivian P.;Pope, Janet E.
Objective.抗瓜氨酸蛋白抗体（ACPA）与类风湿因子（RF）一样敏感，但比RF更特异，在类风湿关节炎（RA）中更早检测到。虽然是RA分类标准的一部分，但ACPA测试并非在所有司法管辖区都定期支付/获得。缺失ACPA测试的影响进行了研究，以确定是否未能执行ACPA测试可能会导致早期炎性关节炎的护理差距。将招募到早期炎性关节炎队列的近2000名患者（n = 1998）分为3组：（1）血清阳性（RF+或ACPA+），（2）血清阴性（RF-和ACPA-），（3）ACPA缺失和RF-。如果p < 0.1，则调整年龄、性别、症状持续时间和吸烟状况的分析。研究了3个月时28个关节的疾病活动度评分（DAS 28），因为在此之后，疾病活动度预计将决定是否继续治疗。符合2010年美国风湿病学会/欧洲抗风湿联盟RA标准的血清阳性患者多于血清阴性患者。第3组年龄稍大，女性比例较小，症状持续时间较短，吸烟较少。在3个月时，第3组与第1组和第2组相比，使用较少的缓解疾病的抗风湿药物和甲氨蝶呤（p < 0.00002），但在DAS 28、健康评估能力-残疾指数（HAQ-DI）、接受皮质类固醇的比例或医生/患者的总体评估方面没有显著差异。在RF阴性、未知ACPA组中不存在护理差距，因为尽管治疗较少，但DAS 28、DAS 28的3个月变化或HAQ-DI无显著差异。在疑似RA患者中确保ACPA检测可用性的成本效益尚不清楚，因为无论是否提供ACPA，早期结局均无差异。
Objective. Anticitrullinated protein antibody (ACPA) is as sensitive as, but more specific than, rheumatoid factor (RF) and is detected earlier in rheumatoid arthritis (RA). Although part of the RA classification criteria, ACPA testing is not routinely paid for/accessible in all jurisdictions. The effect of missing ACPA testing was studied to determine whether failure to perform ACPA testing could cause a care gap in early inflammatory arthritis.Methods. Nearly 2000 patients (n = 1998) recruited to an early inflammatory arthritis cohort were allocated into 3 groups: (1) seropositive (either RF+ or ACPA+), (2) seronegative (RF- and ACPA-), and (3) missing ACPA and RF-. Analyses were adjusted for age, sex, symptom duration, and smoking status if p < 0.1. Disease Activity Score at 28 joints (DAS28) at 3 months was studied, because beyond then, disease activity is expected to determine ongoing treatment.Results. More seropositive patients fulfilled the 2010 American College of Rheumatology/European League Against Rheumatism RA criteria than seronegative patients. Group 3 was slightly older and had a smaller percentage of females, as well as shorter symptom duration and less smoking. At 3 months, group 3 was treated with fewer disease-modifying antirheumatic drugs and methotrexate (p < 0.00002) than groups 1 and 2, but there were no significant differences in DAS28, Health Assessment Questionnaire-Disability Index (HAQ-DI), proportion receiving corticosteroids, or physician's/patient's global assessments.Conclusion. There was no care gap in the RF-negative, unknown ACPA group because there were no significant differences in the DAS28, 3-month change in DAS28, or HAQ-DI, despite less treatment. Cost-effectiveness of ensuring ACPA testing availability in suspected RA is unknown because early outcomes did not differ, whether or not ACPA was available.