Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
Rheumatology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.
Ann Rheum Dis. 2017 Apr;76(4):716-720. doi: 10.1136/annrheumdis-2016-209794. Epub 2016 Nov 9.
In rheumatoid arthritis (RA), seropositive and seronegative disease may be two entities with different underlying pathophysiological mechanisms, long-term outcomes and disease presentations. However, the effect of the conjoint presence of multiple autoantibodies, as proxy for a more pronounced humoral autoimmune response, on clinical phenotype remains unclear. Therefore, this study investigates the association between the number of autoantibodies and initial clinical presentation in two independent cohorts of patients with early RA.
Autoantibody status (rheumatoid factor, anticitrullinated protein antibodies and anticarbamylated protein antibodies) was determined at baseline in the Leiden Early Arthritis Cohort (n=828) and the Swedish BARFOT (Better Anti-Rheumatic Farmaco-Therapy, n=802) study. The association between the number of autoantibodies and baseline clinical characteristics was investigated using univariable and multivariable ordinal regression.
In both cohorts, the following independent associations were found in multivariable analysis: patients with a higher number of RA-associated antibodies were younger, more often smokers, had a longer symptom duration and a higher erythrocyte sedimentation rate at presentation compared with patients with few autoantibodies.
The number of autoantibodies, reflecting the breadth of the humoral autoimmune response, is associated with the clinical presentation of RA. Predisease pathophysiology is thus reflected by the initial clinical phenotype.
在类风湿关节炎（RA）中，血清阳性和血清阴性疾病可能是两种具有不同潜在病理生理机制、长期结局和疾病表现的实体。然而，联合存在多种自身抗体（作为更明显的体液自身免疫反应的代表）对临床表型的影响仍不清楚。因此，本研究在两个独立的早期 RA 患者队列中调查了自身抗体数量与初始临床表型之间的关联。
在莱顿早期关节炎队列（n=828）和瑞典 BARFOT（更好的抗风湿药物治疗，n=802）研究中，在基线时确定自身抗体状态（类风湿因子、抗瓜氨酸化蛋白抗体和抗氨甲酰化蛋白抗体）。使用单变量和多变量有序回归分析研究了自身抗体数量与基线临床特征之间的关联。
在两个队列中，多变量分析均发现以下独立关联：与抗体数量少的患者相比，具有更多 RA 相关抗体的患者更年轻、更多吸烟、起病时症状持续时间更长、红细胞沉降率更高。
自身抗体数量反映了体液自身免疫反应的广度，与 RA 的临床表型相关。因此，发病前的病理生理学反映在初始临床表型中。
