抗核周因子、抗瓜氨酸化肽抗体及类风湿因子在早期类风湿关节炎中的预后价值

The prognostic value of the antiperinuclear factor, anti-citrullinated peptide antibodies and rheumatoid factor in early rheumatoid arthritis.

作者信息

van Jaarsveld C H, ter Borg E J, Jacobs J W, Schellekens G A, Gmelig-Meyling F H, van Booma-Frankfort C, de Jong B A, van Venrooij W J, Bijlsma J W

机构信息

Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, The Netherlands.

出版信息

Clin Exp Rheumatol. 1999 Nov-Dec;17(6):689-97.

PMID:10609067

Abstract

OBJECTIVE

To study the prognostic value of the antiperinuclear factor (APF), determined by an indirect immunofluorescence test (IIF) and a recently developed anti-citrullinated cyclic peptide (CCP) ELISA, in combination with rheumatoid factor (RF) status, in early RA (< 1 year).

METHODS

A total of 249 participants in a randomized trial of treatment strategies were divided into 4 groups according to their APF (or CCP) and RF status at baseline. Differences in disability, joint involvement and radiological damage over a 3-year period were analysed.

RESULTS

APF-IIF results differed from CCP-ELISA in 42 cases (17%); 38 of the 42 had a positive IIF and negative ELISA value. Disability after 3 years did not differ significantly between the RF and APF groups. APF- patients had significantly lower Thompson joint scores compared to APF+ patients (6 vs 24 for CCP-ELISA; 2 vs 24 for IIF). RF+APF+ patients exhibited more radiological damage compared to RF-APF- patients. RF+APF- and RF-APF+ patients had intermediate scores. Within the RF+ and RF- groups, APF+ was associated with more radiological damage and thus yielded prognostic information in addition to RF. In this respect, the results of ELISA and IIF were comparable. Thirty percent of the RF+APF+ patients had a radiological score higher than 45, compared to 13% of the RF+APF-, none of the RF-APF+, and 2% of RF-APF- patients (p < 0.001). In addition, more large joints were affected in APF+ than in APF- patients, while no difference was observed between RF+ and RF- patients.

CONCLUSION

APF has prognostic value in addition to RF for joint involvement and radiological damage in early RA. The CCP-ELISA technique for APF assessment may facilitate its use in clinical practice. However, the prognostic value of the two tests lies in their ability to predict mild disease. Reliable identification at baseline of individual patients with progressive disease is still not possible.

摘要

目的

研究通过间接免疫荧光试验（IIF）和最近开发的抗瓜氨酸化环肽（CCP）酶联免疫吸附测定（ELISA）测定的抗核周因子（APF）联合类风湿因子（RF）状态在早期类风湿关节炎（RA，病程<1年）中的预后价值。

方法

一项治疗策略随机试验中的249名参与者根据其基线时的APF（或CCP）和RF状态被分为4组。分析了3年期间残疾、关节受累情况和放射学损伤的差异。

结果

42例（17%）患者的APF-IIF结果与CCP-ELISA结果不同；这42例患者中有38例IIF结果为阳性而ELISA结果为阴性。3年后，RF组和APF组之间的残疾情况无显著差异。与APF阳性患者相比，APF阴性患者的汤普森关节评分显著更低（CCP-ELISA法：分别为6分和24分；IIF法：分别为2分和24分）。与RF-APF-患者相比，RF+APF+患者表现出更多的放射学损伤。RF+APF-和RF-APF+患者的评分处于中间水平。在RF+组和RF-组中，APF阳性均与更多的放射学损伤相关，因此除RF外还可提供预后信息。在这方面，ELISA和IIF的结果具有可比性。RF+APF+患者中有30%的放射学评分高于45分，相比之下，RF+APF-患者中为13%，RF-APF+患者中无人达到，RF-APF-患者中为2%（p<0.001）。此外，APF阳性患者比APF阴性患者有更多的大关节受累，而RF+和RF-患者之间未观察到差异。