Arthritis Unit, Rheumatology Service, Hospital Clínic of Barcelona, Barcelona, Spain.
J Rheumatol. 2012 Oct;39(10):1929-33. doi: 10.3899/jrheum.120568. Epub 2012 Aug 1.
To analyze longterm progression to rheumatoid arthritis (RA) and the predictive value of anticitrullinated peptide/protein antibodies (ACPA) in palindromic rheumatism (PR).
We selected all patients in our clinic with PR who had at least 1 ACPA measurement. We included only patients with pure PR, defined as no evidence of associated rheumatic disease at the first serum ACPA measurement. Clinical characteristics, serum ACPA levels, duration of PR until serum ACPA measurement, and total followup time were recorded. The outcome variable was the definitive diagnosis of RA. The prognostic value of ACPA status in pure PR for a definite diagnosis of RA was analyzed by different statistical methods.
Seventy-one patients (54 women/17 men) with a PR diagnosis were included. Serum ACPA were positive in 52.1%. After a mean followup of 7.6 ± 4.7 years since the first ACPA measurement, 24 patients (33.8%) progressed to chronic disease: 22% RA, 5.6% systemic lupus erythematosus, and 5.6% other diseases. The positive likelihood ratio of ACPA status for RA was 1.45, and the area under the receiver-operating characteristic curve of ACPA titers was 0.60 (95% CI 0.45-0.75). Progression to RA was more frequently seen in ACPA-positive than in ACPA-negative patients (29.7% vs 14.7%), but the difference was not significant (hazard ratio 2.46, 95% CI 0.77-7.86). Mean ACPA levels of patients with pure PR did not differ significantly from those of patients who progressed to RA.
ACPA are frequently found in the sera of patients with PR, and a significant proportion of these patients do not progress to RA in the long term.
分析回纹型风湿症（PR）患者发生类风湿关节炎（RA）的长期进展情况，以及抗瓜氨酸化肽/蛋白抗体（ACPA）的预测价值。
我们选择了本诊所中至少进行过一次 ACPA 检测的所有 PR 患者。我们仅纳入首次 ACPA 检测时无相关风湿性疾病证据的单纯 PR 患者。记录了临床特征、血清 ACPA 水平、PR 至血清 ACPA 检测的时间以及总随访时间。结局变量为 RA 的明确诊断。通过不同的统计学方法分析单纯 PR 患者的 ACPA 状态对 RA 明确诊断的预后价值。
共纳入 71 例（54 名女性/17 名男性）PR 患者。血清 ACPA 阳性率为 52.1%。自首次 ACPA 检测以来平均随访 7.6±4.7 年后，24 例（33.8%）患者进展为慢性疾病：22%为 RA，5.6%为系统性红斑狼疮，5.6%为其他疾病。ACPA 状态对 RA 的阳性似然比为 1.45，ACPA 滴度的受试者工作特征曲线下面积为 0.60（95%CI 0.45-0.75）。ACPA 阳性患者比 ACPA 阴性患者更常进展为 RA（29.7%比 14.7%），但差异无统计学意义（风险比 2.46，95%CI 0.77-7.86）。单纯 PR 患者的平均 ACPA 水平与进展为 RA 的患者无显著差异。
ACPA 常存在于 PR 患者的血清中，其中相当一部分患者在长期内不会进展为 RA。
