Reid Alistair B, Wiese Michael, McWilliams Leah, Metcalf Rob, Hall Cindy, Lee Anita, Hill Catherine, Wechalekar Mihir, Cleland Les, Proudman Susanna M
Department of Rheumatology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Department of Medicine, The University of Adelaide, Adelaide, South Australia, Australia.
Intern Med J. 2020 Jul;50(7):818-822. doi: 10.1111/imj.14463.
To Investigate the prevalence of seroconversion to ACPA after commencement of triple disease-modifying anti-rheumatic drug (DMARD) treat-to-target therapy.
Anti-citrullinated peptide antibody (ACPA) and rheumatoid factor (RF) define 'seropositive' rheumatoid arthritis (RA). Both predict unfavourable disease course, development of extra-articular features and treatment outcomes. We investigated the prevalence of seroconversion to ACPA after commencement of triple disease-modifying anti-rheumatic drug (DMARD) treat-to-target therapy.
DMARD-naïve patients with RA according to the 1987 American College of Rheumatology criteria and disease duration of <96 weeks were enrolled. RF and ACPA levels were recorded at baseline and sequentially during triple DMARD therapy.
A total of 368 patients were followed for a median of 272 weeks. Of 154 patients seronegative for ACPA at recruitment, 10 (6.5%) seroconverted at some point. Nine of these were positive for RF at baseline and baseline RF titre was predictive of seroconversion. Four (2.6%) patients remained seropositive. No patients seroconverted from negative to positive for both RF and ACPA. Median time to seroconversion for ACPA was 29 months.
Persistent seroconversion of ACPA from negative to positive after diagnosis in patients with RA is uncommon. ACPA and RF double negative patients are highly unlikely to ever develop ACPA positivity with a risk <1%. It is therefore unlikely to be helpful or cost effective to perform serial ACPA measurements in patients with seronegative RA after commencement of a treat-to-target strategy.
调查三联改善病情抗风湿药物（DMARD）达标治疗开始后抗环瓜氨酸肽抗体（ACPA）血清学转换的发生率。
抗瓜氨酸化肽抗体（ACPA）和类风湿因子（RF）可用于定义“血清学阳性”类风湿关节炎（RA）。二者均能预测疾病的不良进程、关节外表现的发生以及治疗结果。我们调查了三联改善病情抗风湿药物（DMARD）达标治疗开始后ACPA血清学转换的发生率。
纳入符合1987年美国风湿病学会标准、病程<96周且未使用过DMARD的RA患者。在三联DMARD治疗期间，记录基线时以及随后的RF和ACPA水平。
共对368例患者进行了中位时间为272周的随访。在入组时ACPA血清学阴性的154例患者中，有10例（6.5%）在某个时间点发生了血清学转换。其中9例在基线时RF为阳性，基线RF滴度可预测血清学转换。4例（2.6%）患者仍为血清学阳性。没有患者的RF和ACPA均从阴性转为阳性。ACPA血清学转换的中位时间为29个月。
RA患者诊断后ACPA持续从阴性转为阳性的情况并不常见。ACPA和RF双阴性的患者极不可能出现ACPA阳性，风险<1%。因此，在血清学阴性的RA患者开始达标治疗策略后，进行系列ACPA检测可能既无帮助也不具有成本效益。
