Anti-Sa antibodies and antibodies against cyclic citrullinated peptide are not equivalent as predictors of severe outcomes in patients with recent-onset polyarthritis

Gilles Boire, Pierre Cossette, Artur J de Brum-Fernandes, Patrick Liang, Théophile Niyonsenga, Zhijie J Zhou, Nathalie Carrier, Claude Daniel, Henri-A Ménard, Gilles Boire, Pierre Cossette, Artur J de Brum-Fernandes, Patrick Liang, Théophile Niyonsenga, Zhijie J Zhou, Nathalie Carrier, Claude Daniel, Henri-A Ménard

Abstract

The prognostic value of two antibodies targeting citrullinated antigens, anti-Sa and anti-cyclic citrullinated peptide (CCP), present at inclusion, was evaluated prospectively in a cohort of 165 consecutive patients with recent-onset or early polyarthritis (EPA) followed for up to 30 months. Patients were treated according to current Good Clinical Practice standards. Predefined outcomes were severe arthritis and persistent arthritis. At inclusion, a median of 3 months after disease onset, 133 (81%) patients fulfilled at least four American College of Rheumatology criteria for rheumatoid arthritis and 30 (18%) had erosive changes on radiographs of hands and feet. Disease-modifying anti-rheumatic drugs were used in close to 80% of the patients at 30 months. Joint damage increased linearly over time, whereas disease activity declined markedly and remained low at each follow-up. Autoantibodies were identified in 76 (46%) patients: rheumatoid factor (RF) in 68 (41%), anti-CCP in 53 (33%), and anti-Sa in 46 (28%). All three antibodies were correlated, but anti-Sa antibodies best predicted severity at 18 and 30 months. RF and anti-CCP performed less well. For both outcomes, anti-Sa alone performed better than any combination of antibodies. The presence of any autoantibody identified about 50 to 60% of the patients with poor outcomes. In multivariate analysis, anti-Sa (odds ratio (OR) 8.83), the presence of erosions at inclusion (OR 3.47) and increasing age (OR 1.06/year) were significantly associated with severity, whereas RF and anti-CCP were not significant predictors. Persistent arthritis was present in up to 84% of patients; autoantibodies were specific but poorly sensitive predictors of this outcome. We conclude that assays for antibodies against citrullinated antigens differ in their ability to predict poorer outcomes in patients with EPA. In our EPA cohort treated in accordance with current standards, detection of anti-Sa but not of RF or anti-CCP antibodies, in combination with clinical and radiological variables present at the first encounter, allowed the identification of a subgroup of EPA patients suffering more rapid and more severe joint damage over 30 months.

Figures

Figure 1
Figure 1
Total Sharp–van der Heijde (SvH) score at inclusion and at 18 and 30 months. Mean values and 95% confidence limits are illustrated. The four curves represent groups of patients at inclusion who had an erosion SvH score of at least 5 and positive anti-Sa (15, 14, and 14 patients at each visit) (squares), an erosion SvH score of at least 5 and negative anti-Sa (15, 13, and 13 patients at each visit) (circles), an erosion SvH score of 4 or less and positive anti-Sa (32, 30, and 30 patients at each visit) (triangles), and an erosion SvH score of 4 or less and negative anti-Sa (103, 97, and 92 patients at each visit) (diamonds).

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