Syversen S W, Gaarder P I, Goll G L, Ødegård S, Haavardsholm E A, Mowinckel P, van der Heijde D, Landewé R, Kvien T K
Department of Rheumatology, Diakonhjemmet Hospital, PB 23 Vindern, N-0319 Oslo, Norway.
Ann Rheum Dis. 2008 Feb;67(2):212-7. doi: 10.1136/ard.2006.068247. Epub 2007 May 25.
New effective therapies with particularly good effect on joint destruction have highlighted the need for reliable predictors of radiographic progression in rheumatoid arthritis (RA). Our objective was to assess the combined predictive role of a set of laboratory markers with regard to 10-year radiographic progression, and to examine the effect of anti-cyclic citrullinated peptide (anti-CCP) level.
A cohort of 238 patients with RA was followed longitudinally for 10 years with the collection of clinical data and serum samples. 125 patients with radiographs of the hands available at both baseline and after 10 years were included in this study. Radiographs were scored according to the van der Heijde modified Sharp score. Baseline sera were analysed for C-reactive protein, erythrocyte sedimentation rate (ESR), anti-CCP, IgA rheumatoid factor (RF) and IgM RF. Logistic regression analyses were used to identify predictors of radiographic progression and to examine the effect of anti-CCP level.
Anti-CCP (OR 4.0; 95% CI 1.6 to 10.0) was the strongest independent predictor of radiographic progression. Female gender (OR 3.3; 95% CI 1.3 to 7.6), high ESR (OR 3.2; 95% CI 1.2 to 7.6) and a positive IgM RF (OR 3.1; 95% CI 1.2 to 7.9) were also independent predictors. Compared with the anti-CCP-negative patients, patients with low to moderate levels of anti-CCP (OR 2.6; 95% CI 0.9 to 7.2) and patients with high levels of anti-CCP (OR 9.9; 95% CI 2.7 to 36.7) were more likely to develop radiographic progression.
Anti-CCP, IgM RF, ESR and female gender were independent predictors of radiographic progression and could be combined into an algorithm for better prediction. Patients with high levels of anti-CCP were especially prone to radiographic progression, indicating that the anti-CCP level may add prognostic information.
对关节破坏有特别良好疗效的新型有效疗法凸显了类风湿关节炎（RA）中可靠的影像学进展预测指标的必要性。我们的目的是评估一组实验室指标对10年影像学进展的联合预测作用，并研究抗环瓜氨酸肽（抗CCP）水平的影响。
对238例RA患者进行了为期10年的纵向随访，收集临床数据和血清样本。本研究纳入了125例在基线和10年后均有手部X线片的患者。根据范德海伊德改良夏普评分对手部X线片进行评分。对基线血清进行C反应蛋白、红细胞沉降率（ESR）、抗CCP、IgA类风湿因子（RF）和IgM RF分析。采用逻辑回归分析确定影像学进展的预测指标，并研究抗CCP水平的影响。
抗CCP（比值比4.0；95%可信区间1.6至10.0）是影像学进展最强的独立预测指标。女性（比值比3.3；95%可信区间1.3至7.6）、高ESR（比值比3.2；95%可信区间1.2至7.6）和IgM RF阳性（比值比3.1；95%可信区间1.2至7.9）也是独立预测指标。与抗CCP阴性患者相比，抗CCP水平低至中度的患者（比值比2.6；95%可信区间0.9至7.2）和抗CCP水平高的患者（比值比9.9；95%可信区间2.7至36.7）更易发生影像学进展。
抗CCP、IgM RF、ESR和女性是影像学进展的独立预测指标，可组合成一种算法以进行更好的预测。抗CCP水平高的患者尤其易发生影像学进展，表明抗CCP水平可能增加预后信息。
