检测第三代环瓜氨酸肽（抗-CCP3）抗体在具有新的肌肉骨骼症状但第二代环瓜氨酸肽（抗-CCP2）抗体检测阴性的个体中的效用。
Utility of testing for third-generation anticyclic citrullinated peptide (anti-CCP3) antibodies in individuals who present with new musculoskeletal symptoms but have a negative second-generation anticyclic citrullinated peptide (anti-CCP2) antibody test.
机构信息
Leeds Institute of Rheumatic and Musculoskeletal Disease, University of Leeds, Leeds, UK.
NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
出版信息
RMD Open. 2024 Apr 10;10(2):e003927. doi: 10.1136/rmdopen-2023-003927.
OBJECTIVES
To investigate the role of third-generation anticyclic citrullinated peptide (anti-CCP3) antibodies in predicting progression to inflammatory arthritis (IA) in individuals with new musculoskeletal (MSK) symptoms and a negative second-generation anti-CCP antibody test (anti-CCP2-).
METHODS
469 anti-CCP2- individuals underwent baseline anti-CCP3 testing (QUANTA Lite CCP3; Inova Diagnostics) and received a post enrolment 12-month questionnaire. A rheumatologist confirmed or excluded diagnosis of IA. Univariable/multivariable analyses were performed to assess the value of anti-CCP3 in predicting IA development in these anti-CCP2- individuals.
RESULTS
Only 16/469 (3.4%) anti-CCP2- individuals had a positive anti-CCP3 test. Of these 16 individuals, 4 developed IA. In addition, 61/469 (13.0%) anti-CCP2- individuals self-reported, to have developed, IA. Progression was confirmed in 43/61 of them (70.5%); of whom 30/43 (69.8%) and 13/43 (30.2%) were given a diagnosis of IA and rheumatoid arthritis (RA), respectively. In qualitative univariable analysis, anti-CCP3 positivity was associated with self-reported progression (p<0.01) and IA (p=0.03), but not with RA. Anti-CCP3 levels differed significantly between progressors and non-progressors (p<0.01) for all three categories. At the manufacturer's cut-off, OR for progression ranged from 2.4 (95% CI 0.5 to 18.6; RA) to 7.5 (95% CI 2.3 to 24.0; self-reported progression). Interestingly, when cut-offs for anti-CCP3 were optimised, lower values (≥5 units) significantly increased the OR for progression in all three categories. In multivariable analysis, anti-CCP3 positivity at the manufacturer's cut-off did not remain associated with IA progression, while this lower cut-off value (≥5 units) was associated with diagnosis of RA (p=0.02).
CONCLUSIONS
Anti-CCP3 testing could improve the prediction of IA development in anti-CCP2- individuals with new MSK symptoms.
目的
研究第三代环瓜氨酸肽（抗-CCP3）抗体在预测新出现的肌肉骨骼（MSK）症状且第二代抗 CCP 抗体检测（抗-CCP2-）阴性的个体中发展为炎症性关节炎（IA）中的作用。
方法
469 名抗-CCP2-个体进行了基线抗-CCP3 检测（QUANTA Lite CCP3；Inova Diagnostics），并在入组后 12 个月接受了问卷调查。一名风湿病学家确认或排除了 IA 的诊断。对单变量/多变量分析进行了评估，以评估抗-CCP3 在预测这些抗-CCP2-个体中 IA 发展方面的价值。
结果
在 469 名抗-CCP2-个体中，仅有 16 名（3.4%）的抗-CCP3 检测呈阳性。这 16 名个体中，有 4 名发展为 IA。此外，61 名抗-CCP2-个体自述出现了 IA。在他们中，43 名（70.5%）被确诊为 IA，其中 30 名（69.8%）和 13 名（30.2%）分别被诊断为 IA 和类风湿关节炎（RA）。在定性单变量分析中，抗-CCP3 阳性与自述进展（p<0.01）和 IA（p=0.03）相关，但与 RA 不相关。在所有三个类别中，进展者和非进展者的抗-CCP3 水平差异显著（p<0.01）。在制造商的截止值处，进展的 OR 范围为 2.4（95%CI 0.5 至 18.6；RA）至 7.5（95%CI 2.3 至 24.0；自述进展）。有趣的是，当优化抗-CCP3 的截止值时，所有三个类别的较低值（≥5 单位）显著增加了进展的 OR。在多变量分析中，制造商截止值处的抗-CCP3 阳性与 IA 进展不再相关，而较低的截止值（≥5 单位）与 RA 诊断相关（p=0.02）。
结论
抗-CCP3 检测可提高对新出现的 MSK 症状且抗-CCP2-个体中 IA 发展的预测。
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