Anti-cyclic citrullinated peptide antibody predicts the development of rheumatoid arthritis in patients with undifferentiated arthritis

• Main Authors: Chun Li, Yan Zhang, Hui Song, Jie Gao, Dong-Bao Zhao, Qi Zhu, Dong-Yi He, Li Wang, Xiang-Pei Li, Xu-Dong Liu, Wei-Guo Xiao, Xin-Yu Wu, Hua-Xiang Wu, Wei Tu, Shao-Xian Hu, Xin Wang, Zhi-Jun Li, Zhi-Min Lu, Zhan-Yun Da, Bo Liang, Xiao-Min Liu, Jin-Wei Zhao, Ling Li, Feng Han, Wu-Fang Qi, Wei Wei, Xu Ma, Zhen-Bin Li, Gui-Min Zheng, Feng-Xiao Zhang, Yi Li, You-Lian Wang, Guang-Hui Ling, Jin-Wei Chen, Xiao-Qiang Hou, Jing Zhang, Qing-Ping Chen, Chang-Lian Liu, Jia-Shun Zeng, Qing-Hua Zou, Yong-Fei Fang, Yin Su, Zhan-Guo Li, Ning-Ning Wang
• Format: Article
• Language: English
• Published: Wolters Kluwer 2019-12-01
• Series: Chinese Medical Journal
• Online Access: http://journals.lww.com/10.1097/CM9.0000000000000570

Abstract. Background:. Clinical outcomes of undifferentiated arthritis (UA) are diverse, and only 40% of patients with UA develop rheumatoid arthritis (RA) after 3 years. Discovering predictive markers at disease onset for further intervention is critical. Therefore, our objective was to analyze the clinical outcomes of UA and ascertain the predictors for RA development. Methods:. We performed a prospective, multi-center study from January 2013 to October 2016 among Chinese patients diagnosed with UA in 22 tertiary-care hospitals. Clinical and serological parameters were obtained at recruitment. Follow-up was undertaken in all patients every 12 weeks for 2 years. Predictive factors of disease progression were identified using multivariate Cox proportional hazards regression. Results:. A total of 234 patients were recruited in this study, and 17 (7.3%) patients failed to follow up during the study. Among the 217 patients who completed the study, 83 (38.2%) patients went into remission. UA patients who developed RA had a higher rheumatoid factor (RF)-positivity (42.9% vs. 16.8%, χ2 = 8.228, P = 0.008), anti-cyclic citrullinated peptide (CCP) antibody-positivity (66.7% vs. 10.7%, χ2 = 43.897, P < 0.001), and double-positivity rate of RF and anti-CCP antibody (38.1% vs. 4.1%, χ2 = 32.131, P < 0.001) than those who did not. Anti-CCP antibody but not RF was an independent predictor for RA development (hazard ratio 18.017, 95% confidence interval: 5.803–55.938; P < 0.001). Conclusion:. As an independent predictor of RA, anti-CCP antibody should be tested at disease onset in all patients with UA.