Prognosis of Seronegative Patients in a Large Prospective Cohort of Patients with Early Inflammatory Arthritis
Prognosis of Seronegative Patients in a Large Prospective Cohort of Patients with Early Inflammatory Arthritis
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DOI：
10.3899/jrheum.140082
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发表时间：
2014-12-01
影响因子：
3.9
通讯作者：
Bykerk, Vivian P.
中科院分区：
文献类型：
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作者：
Barra, Lillian;Pope, Janet E.;Bykerk, Vivian P.
Objective.风湿因子（RF）和抗瓜氨酸蛋白抗体（ACPA）被认为与更严重的类风湿性关节炎有关;然而，早期炎症性关节炎（EIA）的研究产生了相互矛盾的结果。我们的研究确定了基线ACPA阴性和RF阴性患者的预后。入组加拿大早期关节炎队列的患者在基线时测量IgM RF和IgG抗环瓜氨酸肽抗体2（抗CCP 2）。在12个月和24个月的随访中，使用logistic回归分析解释混杂因素，将28个关节的疾病活动评分（DAS 28）< 2.6定义为缓解。在841例患者中，216例（26%）RF和抗CCP 2均为阴性。与血清阳性受试者相比，血清阴性受试者年龄较大（57 +/- 15 vs 51 +/- 14岁），男性比例更高（31%对23%），症状持续时间较短（166 +/- 87 vs 192 +/- 98天），基线时平均肿胀关节计数较高（SJC; 8.8 +/- 6.8 vs 6.5 +/- 5.6）、DAS 28（5.0 +/- 1.6 vs 4.8 +/- 1.5）和糜烂性疾病（32% vs 24%，p < 0.05）。两组之间的治疗相似。在24个月随访时，血清阴性受试者的平均变化大于血清阳性受试者（Delta +/- SD）疾病活动性测量：Δ SJC计数（-6.9 +/- 7.0 vs -5.1 +/- 5.9）、Delta DAS 28（-2.4 +/- 2.0 vs -1.8 +/- 1.8）和Delta C反应蛋白（-11.0 +/- 17.9 vs -6.4 +/- 17.5，p < 0.05）。考虑到混杂因素，抗体状态与缓解无显著相关性。然而，在12个月的随访中，ACPA阳性的受试者独立地更有可能发生新的糜烂性疾病（OR 2.94，95%CI 1.45-5.94）。尽管EIA血清阴性受试者的基线DAS 28高于血清阳性受试者，但他们对治疗的反应良好，并且在随访期间不太可能发生糜烂性疾病。
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 (Delta +/- SD) in disease activity measures: Delta SJC counts (-6.9 +/- 7.0 vs -5.1 +/- 5.9), Delta DAS28 (-2.4 +/- 2.0 vs -1.8 +/- 1.8), and Delta C-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.