Leeds Institute of Rheumatic and Musculoskeletal Disease, University of Leeds, Leeds, UK.
NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
RMD Open. 2024 Apr 10;10(2):e003927. doi: 10.1136/rmdopen-2023-003927.
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-).
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.
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).
Anti-CCP3 testing could improve the prediction of IA development in anti-CCP2- individuals with new MSK symptoms.
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。
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。
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）。
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。
