Enriching case selection for imminent RA: the use of anti-CCP antibodies in individuals with new non-specific musculoskeletal symptoms - a cohort study - PubMed (original) (raw)

Clinical Trial

Enriching case selection for imminent RA: the use of anti-CCP antibodies in individuals with new non-specific musculoskeletal symptoms - a cohort study

Jacqueline L Nam et al. Ann Rheum Dis. 2016 Aug.

Free article

Abstract

Objectives: Around 1% of the population test positive for anti-cyclic citrullinated peptide (anti-CCP) antibodies. This biomarker predicts the progression to rheumatoid arthritis (RA) but over a variable time frame. To increase its clinical relevance, this study sought to determine (1) if the proportion of anti-CCP-positive individuals could be enriched by case selection of people attending primary care with new non-specific musculoskeletal (MSK) symptoms but without clinical synovitis (CS) and (2) whether these individuals progress rapidly to inflammatory arthritis (IA), in particular RA.

Methods: In this prospective cohort study, individuals aged ≥18 years with new non-specific MSK symptoms, without CS, were recruited from primary care in the UK. Anti-CCP-positive individuals were invited for follow-up in the rheumatology department, Leeds. Those who tested negative were sent questionnaires 12 months later.

Results: 2028 individuals were recruited. Of these, 2.8% (57/2028) were anti-CCP positive, of whom 47% (27/57) developed IA - 24 RA, 1 undifferentiated IA (UIA), 2 polymyositis; 92.6% (25/27) within 12 months, median 1.8 months (IQR 1.0-4.3, range 0.3-16.1). Of the anti-CCP-negative individuals, 1.3% (20/1559) developed IA (1 UIA, 13 RA, 6 psoriatic arthritis); 75% (15/20) within 12 months. The relative risk for developing RA within 12 months in the anti-CCP-positive group was 66.8 (95% CI 32.2 to 138.4, p<0.001); for IA, it was 45.5 (95% CI 25.4 to 81.6, p<0.001).

Conclusions: Selecting individuals with new non-specific MSK symptoms without CS enriched the prevalence of anti-CCP positivity to 2.8%. Those who tested positive had a high risk of rapidly developing RA. The cost-effectiveness of this approach will need to be determined.

Trial registration number: NCT02012764.

Keywords: Ant-CCP; Autoantibodies; Early Rheumatoid Arthritis; Rheumatoid Arthritis.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

PubMed Disclaimer

Cited by

T-cell subset abnormalities predict progression along the Inflammatory Arthritis disease continuum: implications for management.
Ponchel F, Burska AN, Hunt L, Gul H, Rabin T, Parmar R, Buch MH, Conaghan PG, Emery P. Ponchel F, et al. Sci Rep. 2020 Feb 28;10(1):3669. doi: 10.1038/s41598-020-60314-w. Sci Rep. 2020. PMID: 32111870 Free PMC article. Clinical Trial.
Which patients presenting with arthralgia eventually develop rheumatoid arthritis? The current state of the art.
Boeters DM, Raza K, van der Helm-van Mil AHM. Boeters DM, et al. RMD Open. 2017 Nov 14;3(2):e000479. doi: 10.1136/rmdopen-2017-000479. eCollection 2017. RMD Open. 2017. PMID: 29177078 Free PMC article. Review.
How to Distinguish Non-Inflammatory from Inflammatory Pain in RA?
Khot S, Tackley G, Choy E. Khot S, et al. Curr Rheumatol Rep. 2024 Dec;26(12):403-413. doi: 10.1007/s11926-024-01159-4. Epub 2024 Aug 9. Curr Rheumatol Rep. 2024. PMID: 39120749 Free PMC article. Review.
Perceptions and experiences of individuals at-risk of rheumatoid arthritis (RA) knowing about their risk of developing RA and being offered preventive treatment: systematic review and thematic synthesis of qualitative studies.
Siddle HJ, Chapman LS, Mankia K, Zăbălan C, Kouloumas M, Raza K, Falahee M, Kerry J, Kerschbaumer A, Aletaha D, Emery P, Richards SH. Siddle HJ, et al. Ann Rheum Dis. 2022 Feb;81(2):159-168. doi: 10.1136/annrheumdis-2021-221160. Epub 2021 Nov 8. Ann Rheum Dis. 2022. PMID: 34750103 Free PMC article.
Anti-citrullinated protein antibodies are associated with osteopenia but not with pain at diagnosis of rheumatoid arthritis: data from the BARFOT cohort.
Hafström I, Ajeganova S, Forslind K, Svensson B. Hafström I, et al. Arthritis Res Ther. 2019 Feb 4;21(1):45. doi: 10.1186/s13075-019-1833-y. Arthritis Res Ther. 2019. PMID: 30717793 Free PMC article.

Enriching case selection for imminent RA: the use of anti-CCP antibodies in individuals with new non-specific musculoskeletal symptoms - a cohort study - PubMed (original) (raw)