International Medical University, No: 126 Jalan Jalil Perkasa 19/155B, Bukit Jalil, 57000 Kuala Lumpur, Malaysia.
Mod Rheumatol. 2013 Jul;23(4):716-21. doi: 10.1007/s10165-012-0718-6. Epub 2012 Aug 2.
The prognostic significance of rheumatoid factor (RF) and anticyclic citrullinated peptide antibody (anti-CCP) in rheumatoid arthritis (RA) remains contentious due to the conflicting lines of evidence. This study aims to determine the association between RF isotypes and anti-CCP with disease severity in RA patients from three ethnic groups.
A total of 147 RA patients from three different ethnic groups (Malays, Chinese, and Indians) who fulfilled the 1987 American College of Rheumatology (ACR) revised criteria for RA were recruited into this study. The seroprevalence of RF isotypes immunoglobulin (Ig)A, IgG, and IgM, as well as anti-CCP was determined using commercial enzyme-linked immunosorbent assay (ELISA) kits. Multinomial regression analysis was performed to assess the independent effects of autoantibody status on the development of deforming and erosive RA and the presence of extra-articular manifestations (EAM).
In Chinese patients, we found a significant association (p < 0.05) between IgG RF and anti-CCP and the presence of erosive disease, as well as IgM RF and IgG RF with the presence of joint deformities. In Indian patients, IgM RF was associated with deforming disease, whereas none of the antibodies were associated with disease severity in Malay patients. Multinomial regression analysis revealed that IgG RF was the most important predictor variable for erosive disease in Chinese patients, and IgM RF the only predictor variable associated with deforming disease in both Chinese and Indian RA patients.
There is variability in the phenotypic association of RF isotypes and anti-CCP in relation to disease severity of RA in the three ethnic groups. RF, in particular, IgG and IgM, may be better prognosticators of severe disease in Chinese and Indian patients.
由于证据相互矛盾，类风湿因子（RF）和抗环瓜氨酸肽抗体（抗-CCP）在类风湿关节炎（RA）中的预后意义仍存在争议。本研究旨在确定三种族群体 RA 患者中 RF 同种型和抗-CCP 与疾病严重程度的关系。
本研究共纳入 147 名符合 1987 年美国风湿病学会（ACR）修订的 RA 标准的来自三个不同种族（马来人、华人、印度人）的 RA 患者。使用商业酶联免疫吸附试验（ELISA）试剂盒检测 RF 同种型免疫球蛋白（Ig）A、IgG 和 IgM 以及抗-CCP 的血清阳性率。采用多项回归分析评估自身抗体状态对变形性和侵蚀性 RA 发展以及关节外表现（EAM）存在的独立影响。
在中国患者中，我们发现 IgG RF 和抗-CCP 与侵蚀性疾病的存在以及 IgM RF 和 IgG RF 与关节畸形的存在之间存在显著关联（p < 0.05）。在印度患者中，IgM RF 与变形性疾病相关，而马来患者中没有任何抗体与疾病严重程度相关。多项回归分析显示，在华人患者中，IgG RF 是侵蚀性疾病的最重要预测变量，而在华人及印度 RA 患者中，只有 IgM RF 是与变形性疾病相关的唯一预测变量。
在三种族群体中，RF 同种型和抗-CCP 与 RA 疾病严重程度的表型关联存在差异。RF，特别是 IgG 和 IgM，可能是华人及印度患者严重疾病的更好预后标志物。
