Association of anti-cyclic citrullinated peptide antibodies with clinical and radiological disease severity in rheumatoid arthritis.

OBJECTIVE

This study assessed an association of anti-cyclic citrullinated peptide antibodies (ACPA) with clinical and radiological disease severity in patients with rheumatoid arthritis (RA).

MATERIALS AND METHODS

Fifty patients diagnosed with RA as per 2010 revised American College of Rheumatology/ European League Against Rheumatism (ACR/EULAR) classification criteria were included in this cross-sectional study. Serum levels of ACPA, C-reactive protein (CRP) and rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), disease activity score with 28-joint counts and ESR (DAS28-ESR), patient's global assessment of disease activity using visual analogue scale (PtGA-VAS), modified health assessment questionnaire score (M-HAQ) and radiological damage in hands and feet (modified Larsen score) were determined.

RESULTS

ACPA were positive in 48 (96%) and RF in 44 (88%) patients. Mean Larsen score was 19.82 ± 17.11 and mean DAS28-ESR 6.39 ± 1.59. A significant correlation of ACPA levels was seen with RF (p=0.03) and Larsen score (p=0.02) but not with DAS28-ESR (p=0.17) and M-HAQ (p=0.81). A significant correlation was seen between Larsen score and disease duration (p<0.0001), age (p=0.04), DAS28-ESR (p=0.001) and M-HAQ (p<0.0001). Multivariate analysis showed that painful joint count (p=0.003), ESR (p<0.001) and PtGA-VAS (p=0.009) were independently associated with clinical disease activity severity. Disease duration (p=0.01), ACPA levels (p=0.004) and DAS28-ESR (p=0.03) were independently associated with radiological joint damage.

CONCLUSION

Serum ACPA levels correlate significantly with radiological severity of RA but not with clinical disease severity and are independently associated with radiological outcome.