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Value of anti-modified citrullinated vimentin and third-generation anti-cyclic citrullinated peptide compared with second-generation anti-cyclic citrullinated peptide and rheumatoid factor in predicting disease outcome in undifferentiated arthritis and rheumatoid arthritis
Arthritis & Rheumatism, 08/07/09

van der Linden MPM et al. – Study suggests that for clinical practice, a single autoantibody test (out of anti-CCP-2, anti-CCP-3, anti-MCV, and RF) is sufficient for risk estimation in undifferentiated arthritis (UA) and rheumatoid arthritis (RA).

Methods

An evaluation of the capability of all autoantibodies and combinations of them to predict 3 outcome measures in RA:
1. Progression from UA to RA
2. Rate of joint destruction in RA, and
3. Chance of achieving sustained DMARD-free remission
Pts with UA (n=625) were studied for whether UA progressed to RA after 1 yr
Pts with RA (n=687) were studied for:
- Whether sustained DMARD-free remission was achieved, and
- For the rate of joint destruction during a median f/u of 5 yrs
Positive predictive values (PPVs) for RA development and for associations with the disease course in RA were compared between single tests and combinations of these tests

Results

Among the single tests for UA: anti-CCP-2 had highest PPV for RA development but the 95% CI of the other tests overlapped
Among the single tests for RA: all 4 tests showed comparable associations with the rate of joint destruction and with the achievement of remission
In both ACPA-positive and ACPA-negative RA, the presence of RF was not associated with more joint destruction
For all outcome measures, performing combinations of 2 or 3 autoantibody tests did not increase the predictive accuracy vs a single test

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Prevalence of and predictive factors for sustained...