OBJECTIVE: To investigate the risk of progression to rheumatoid arthritis (RA) in patients who were cyclic citrullinated peptide (CCP) antibody positive without RA at initial presentation. METHODS: We performed a retrospective cohort study of CCP+ individuals seen at a US tertiary care system between 2009 and 2018 who were without RA or other systemic rheumatic disease by medical record review at the time of CCP antibody positivity. Progression to classifiable RA was determined through medical record review. We investigated the risk of progression to RA overall and stratified by CCP antibody level (low: >1 to 2× the upper limit of normal [ULN]; medium: >2 to 3× ULN; high: >3× ULN). Multivariable Cox regression estimated the hazard ratio (HR) and 95% confidence interval (95% CI) for RA by CCP antibody level. RESULTS: We identified 340 CCP+ patients who were without RA or other rheumatic disease at baseline. During 1,047 person-years of follow-up, 73 patients (21.5%) developed RA. The risk of progression to RA increased with CCP antibody level, with 46.0% (95% CI 34.7-55.3) of patients with high-level CCP antibodies progressing to RA by 5 years. Compared to low CCP antibody level, medium (HR 3.00 [95% CI 1.32-6.81]) and high (HR 4.83 [95% CI 2.51-9.31]) CCP antibody levels were strongly associated with progression to RA, adjusting for age, sex, body mass index, smoking, family history of RA, and rheumatoid factor level. CONCLUSION: Among CCP+ patients without RA, the risk for progression to RA increased substantially with increasing CCP antibody level. This study provides further support for close monitoring for development of RA among CCP+ patients and identifying strategies to mitigate this risk.
OBJECTIVE: To investigate the risk of progression to rheumatoid arthritis (RA) in patients who were cyclic citrullinated peptide (CCP) antibody positive without RA at initial presentation. METHODS: We performed a retrospective cohort study of CCP+ individuals seen at a US tertiary care system between 2009 and 2018 who were without RA or other systemic rheumatic disease by medical record review at the time of CCP antibody positivity. Progression to classifiable RA was determined through medical record review. We investigated the risk of progression to RA overall and stratified by CCP antibody level (low: >1 to 2× the upper limit of normal [ULN]; medium: >2 to 3× ULN; high: >3× ULN). Multivariable Cox regression estimated the hazard ratio (HR) and 95% confidence interval (95% CI) for RA by CCP antibody level. RESULTS: We identified 340 CCP+ patients who were without RA or other rheumatic disease at baseline. During 1,047 person-years of follow-up, 73 patients (21.5%) developed RA. The risk of progression to RA increased with CCP antibody level, with 46.0% (95% CI 34.7-55.3) of patients with high-level CCP antibodies progressing to RA by 5 years. Compared to low CCP antibody level, medium (HR 3.00 [95% CI 1.32-6.81]) and high (HR 4.83 [95% CI 2.51-9.31]) CCP antibody levels were strongly associated with progression to RA, adjusting for age, sex, body mass index, smoking, family history of RA, and rheumatoid factor level. CONCLUSION: Among CCP+ patients without RA, the risk for progression to RA increased substantially with increasing CCP antibody level. This study provides further support for close monitoring for development of RA among CCP+ patients and identifying strategies to mitigate this risk.
Authors: Xia Jiang; Thomas Frisell; Johan Askling; Elizabeth W Karlson; Lars Klareskog; Lars Alfredsson; Henrik Källberg Journal: Arthritis Rheumatol Date: 2015-02 Impact factor: 10.995
Authors: Solbritt Rantapää-Dahlqvist; Ben A W de Jong; Ewa Berglin; Göran Hallmans; Göran Wadell; Hans Stenlund; Ulf Sundin; Walther J van Venrooij Journal: Arthritis Rheum Date: 2003-10
Authors: Jan M Hughes-Austin; Kevin D Deane; Lezlie A Derber; Jason R Kolfenbach; Gary O Zerbe; Jeremy Sokolove; Lauren J Lahey; Michael H Weisman; Jane H Buckner; Ted R Mikuls; James R O'Dell; Richard M Keating; Peter K Gregersen; William H Robinson; V Michael Holers; Jill M Norris Journal: Ann Rheum Dis Date: 2012-08-21 Impact factor: 19.103
Authors: Lori B Chibnik; Lisa A Mandl; Karen H Costenbader; Peter H Schur; Elizabeth W Karlson Journal: J Rheumatol Date: 2009-02-17 Impact factor: 4.666
Authors: D Makrygiannakis; M Hermansson; A-K Ulfgren; A P Nicholas; A J W Zendman; A Eklund; J Grunewald; C M Skold; L Klareskog; A I Catrina Journal: Ann Rheum Dis Date: 2008-04-15 Impact factor: 19.103
Authors: W H Bos; G J Wolbink; M Boers; G J Tijhuis; N de Vries; I E van der Horst-Bruinsma; P P Tak; R J van de Stadt; C J van der Laken; B A C Dijkmans; D van Schaardenburg Journal: Ann Rheum Dis Date: 2009-04-09 Impact factor: 19.103
Authors: Cesar Ramos-Remus; Jose Dionisio Castillo-Ortiz; Luis Aguilar-Lozano; Jorge Padilla-Ibarra; Carlos Sandoval-Castro; Cesar Omar Vargas-Serafin; Hector de la Mora-Molina; Ariadna Ramos-Gomez; Adriana Sanchez-Ortiz; Hilario Avila-Armengol; Francisco Javier Aceves-Avila Journal: Arthritis Rheumatol Date: 2015-11 Impact factor: 10.995
Authors: H Maura Friedlander; Julia A Ford; Alessandra Zaccardelli; Alexsandra V Terrio; Michael H Cho; Jeffrey A Sparks Journal: Expert Rev Clin Immunol Date: 2020-01-06 Impact factor: 4.473
Authors: Alessandra Zaccardelli; Xinyi Liu; Julia A Ford; Jing Cui; Bing Lu; Su H Chu; Peter H Schur; Cameron B Speyer; Karen H Costenbader; William H Robinson; Jeremy Sokolove; Elizabeth W Karlson; Carlos A Camargo; Jeffrey A Sparks Journal: Arthritis Care Res (Hoboken) Date: 2021-04 Impact factor: 4.794
Authors: Fenne Wouters; Marc P Maurits; Laurette van Boheemen; Marloes Verstappen; Kulveer Mankia; Xanthe M E Matthijssen; Annemarie L Dorjée; Paul Emery; Rachel Knevel; Dirkjan van Schaardenburg; René E M Toes; Annette H M van der Helm-van Mil Journal: Ann Rheum Dis Date: 2021-07-20 Impact factor: 19.103
Authors: Elizabeth A Bemis; M Kristen Demoruelle; Jennifer A Seifert; Kristen J Polinski; Michael H Weisman; Jane H Buckner; Peter K Gregersen; Ted R Mikuls; James R ODell; Richard M Keating; Kevin D Deane; V Michael Holers; Jill M Norris Journal: Ann Rheum Dis Date: 2020-09-14 Impact factor: 27.973
Authors: Alessandra Zaccardelli; Xinyi Liu; Julia A Ford; Jing Cui; Bing Lu; Su H Chu; Peter H Schur; Cameron B Speyer; Karen H Costenbader; William H Robinson; Jeremy Sokolove; Elizabeth W Karlson; Carlos A Camargo; Jeffrey A Sparks Journal: Arthritis Res Ther Date: 2019-11-21 Impact factor: 5.156