Rheumatology Division, Hospital Universitário de Brasília da Universidade de Brasília, SHLS 716/916 Bloco E salas 501-502, Centro Médico de Brasília, Asa Sul, Brasilia, DF CEP: 71660020, Brazil.
Rheumatol Int. 2012 Dec;32(12):3807-12. doi: 10.1007/s00296-011-2260-9. Epub 2011 Dec 21.
Autoantibodies in early rheumatoid arthritis (RA) have important diagnostic value. The association between the presence of autoantibodies against cyclic citrullinated peptide and the response to treatment is controversial. To prospectively evaluate a cohort of patients with early rheumatoid arthritis (<12 months of symptoms) in order to determine the association between serological markers (rheumatoid factor (RF), anti-citrullinated protein antibodies) such as anti-cyclic citrullinated peptide antibodies (anti-CCP) and citrullinated anti-vimentin (anti-Sa) with the occurrence of clinical remission, forty patients diagnosed with early RA at the time of diagnosis were evaluated and followed for 3 years, in use of standardized therapeutic treatment. Demographic and clinical data were recorded, disease activity score 28 (DAS 28), as well as serology tests (ELISA) for RF (IgM, IgG, and IgA), anti-CCP (CCP2, CCP3, and CCP3.1) and anti-Sa in the initial evaluation and at 3, 6, 12, 18, 24, and 36 months of follow-up. The outcome evaluated was the percentage of patients with clinical remission, which was defined by DAS 28 lower than 2.6. Comparisons were made through the Student t test, mixed-effects regression analysis, and analysis of variance (significance level of 5%). The mean age was 45 years, and a female predominance was observed (90%). At the time of diagnosis, RF was observed in 50% of cases (RF IgA-42%, RF IgG-30%, and RF IgM-50%), anti-CCP in 50% (no difference between CCP2, CCP3, and CCP3.1) and anti-Sa in 10%. After 3 years, no change in the RF prevalence and anti-CCP was observed, but the anti-Sa increased to 17.5% (P = 0.001). The percentage of patients in remission, low, moderate, and intense disease activity, according to the DAS 28, was of 0, 0, 7.5, and 92.5% (initial evaluation) and 22.5, 7.5, 32.5, and 37.5% (after 3 years). There were no associations of the presence of autoantibodies in baseline evaluation and in serial analysis with the percentage of clinical remission during follow-up of 3 years The presence of autoantibodies in early RA has no predictive value for clinical remission in early RA.
早期类风湿关节炎（RA）中的自身抗体具有重要的诊断价值。存在针对环瓜氨酸肽的自身抗体与治疗反应之间的关联存在争议。为了前瞻性评估一组早期类风湿关节炎（<12 个月的症状）患者，以确定血清标志物（类风湿因子（RF）、抗瓜氨酸蛋白抗体）与临床缓解的发生之间的关联，例如抗环瓜氨酸肽抗体（抗-CCP）和瓜氨酸化抗波形蛋白（抗-Sa）。对 40 名在诊断时被诊断为早期 RA 的患者进行评估，并在使用标准化治疗的情况下进行 3 年的随访。记录人口统计学和临床数据、疾病活动评分 28（DAS 28）以及血清学检测（ELISA）用于 RF（IgM、IgG 和 IgA）、抗-CCP（CCP2、CCP3 和 CCP3.1）和抗-Sa 在初始评估以及 3、6、12、18、24 和 36 个月的随访中。评估的结果是临床缓解的患者百分比，通过 DAS 28 低于 2.6 来定义。通过学生 t 检验、混合效应回归分析和方差分析（5%的显著性水平）进行比较。平均年龄为 45 岁，观察到女性占优势（90%）。在诊断时，50%的病例中观察到 RF（RF IgA-42%、RF IgG-30%和 RF IgM-50%）、50%的病例中观察到抗-CCP（CCP2、CCP3 和 CCP3.1 之间无差异）和 10%的病例中观察到抗-Sa。3 年后，RF 的患病率和抗-CCP 没有变化，但抗-Sa 增加到 17.5%（P = 0.001）。根据 DAS 28，缓解、低、中、高强度疾病活动的患者百分比分别为 0、0、7.5 和 92.5%（初始评估）和 22.5、7.5、32.5 和 37.5%（3 年后）。基线评估和连续分析中自身抗体的存在与 3 年随访期间的临床缓解百分比之间没有关联。早期 RA 中的自身抗体对早期 RA 的临床缓解没有预测价值。
