Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany.
Institute of Medical Physics, University of Erlangen-Nuremberg, Erlangen, Germany.
Ann Rheum Dis. 2015 Dec;74(12):2151-6. doi: 10.1136/annrheumdis-2014-205428. Epub 2014 Aug 12.
To determine whether there is an additive effect of anticitrullinated protein antibodies (ACPA) and rheumatoid factor (RF) on the number and size of bone erosions in patients with rheumatoid arthritis (RA) METHODS: 242 patients with RA received high-resolution peripheral quantitative CT (HR-pQCT) scans of the metacarpophalangeal joints. Demographic and disease-specific parameters including ACPA and RF levels were recorded from all patients. Erosion numbers and their size were assessed in 238 patients at 714 individual joints (MCP 2, 3 and 4) and 5712 sites (each 4 quadrants in metacarpal heads and phalangeal bases). The volume of erosions was calculated by a semiellipsoid formula.
Of the 238 patients, 112 patients showed RF and ACPAs (ACPAs+RF+), 28 only RF (RF+), 29 only ACPAs (ACPA+) and 69 were antibody negative (NEG). Erosion number and size were highest in RF+ACPAs+ patient group with significant differences compared with NEG patients with respect to erosion number (p=0.001) and to ACPA-negative patients with respect to erosion size (p<0.001). Results maintained significance in a linear mixed model showing ACPAs+RF+ status and disease duration being associated with higher number (p=0.017 and p=0.005, respectively), and larger size (p=0.014 and p=0.013, respectively) of bone erosions. Furthermore, erosion size was influenced by the presence and titre of RF only in ACPA-positive patients with RA but not in ACPA-negative patients.
ACPAs and RF show an additive effect on erosion number and erosion size. Concomitant presence of ACPAs and RF is associated with higher erosive disease burden in patients with RA. Furthermore, RF influences erosion size only in ACPA-positive but not in ACPA-negative patients.
确定抗瓜氨酸化蛋白抗体（ACPA）和类风湿因子（RF）是否对类风湿关节炎（RA）患者的骨侵蚀数量和大小有附加作用。
242 例 RA 患者接受了掌指关节的高分辨率外周定量 CT（HR-pQCT）扫描。所有患者均记录了人口统计学和疾病特异性参数，包括 ACPA 和 RF 水平。在 238 例患者的 714 个关节（MCP 2、3 和 4）和 5712 个部位（掌骨头部和指骨基底的每个 4 个象限）评估了侵蚀数量及其大小。通过半椭圆公式计算侵蚀体积。
在 238 例患者中，112 例患者显示 RF 和 ACPAs（ACPA+RF+），28 例仅 RF（RF+），29 例仅 ACPAs（ACPA+）和 69 例抗体阴性（NEG）。在 RF+ACPA+患者组中，侵蚀数量和大小最高，与 NEG 患者相比，侵蚀数量差异有统计学意义（p=0.001），与 ACPA 阴性患者相比，侵蚀大小差异有统计学意义（p<0.001）。线性混合模型显示 ACPA+RF+状态和疾病持续时间与更高的侵蚀数量（p=0.017 和 p=0.005）和更大的侵蚀大小（p=0.014 和 p=0.013）相关，结果仍有意义。此外，仅在 RA 中 ACPA 阳性患者中，RF 的存在和滴度影响侵蚀大小，但在 ACPA 阴性患者中则无影响。
ACPA 和 RF 对侵蚀数量和侵蚀大小有相加作用。ACPA 和 RF 的同时存在与 RA 患者更高的侵蚀性疾病负担相关。此外，RF 仅在 ACPA 阳性而非 ACPA 阴性患者中影响侵蚀大小。
