ACPA and RF as predictors of sustained clinical remission in patients with rheumatoid arthritis: data from the Ontario Best practices Research Initiative (OBRI).

Authors:
Janet E Pope
Janet E Pope
University of Western Ontario
Canada
Mohammad Movahedi
Mohammad Movahedi
Shahid Beheshti University of Medical Sciences
Iran
Emmanouil Rampakakis
Emmanouil Rampakakis
McGill University
Canada
Angela Cesta
Angela Cesta
Toronto General Hospital Research Institute
John S Sampalis
John S Sampalis
McGill University
Canada
Edward Keystone
Edward Keystone
University of Toronto
Canada
Carter Thorne
Carter Thorne
From the University of Western Ontario
Claire Bombardier
Claire Bombardier
University of Toronto
Canada

RMD Open 2018 5;4(2):e000738. Epub 2018 Nov 5.

Toronto General Hospital Research Institute, University Health Network, Toronto, London, Canada.

Objectives: This study evaluated the interaction of anticitrullinated protein antibody (ACPA) and rheumatoid factor (RF) in predicting sustained clinical response in an observational registry of patients with rheumatoid arthritis (RA) followed in routine practice.

Methods: Patients with RA enrolled in the Ontario Best Practices Research Initiative registry, with ≥1 swollen joint, autoantibody information and ≥1 follow-up assessment were included. Sustained clinical remission was defined as Clinical Disease Activity Index (CDAI) ≤2.8 in at least two sequential visits separated by 3-12 months. Time to sustained remission was assessed using cumulative incidence curves and multivariate cox regression.

Results: Among 3251 patients in the registry, 970 were included, of whom 262 (27%) were ACPA/RF, 60 (6.2%) ACPA /RF, 117 (12.1%) ACPA/RF and 531 (54.7%) ACPA /RF at baseline. Significant between group differences were observed in age (p=0.02), CDAI (p=0.03), tender joint count (p=0.02) and Health Assessment Questionnaire (p=0.002), with ACPA patients being youngest with lowest disease activity and disability. No difference in biologic use was found between groups (20.2% of patients).Over a mean follow-up of 3 years, sustained remission was achieved by 43.5% of ACPA/RF patients, 43.3% of ACPA /RF patients, 31.6 % of ACPA/RF patients and 32.4% of ACPA/RF patients (p=0.01). Significant differences were observed in CDAI improvement based on ACPA and RF status where ACPA/RF had a shorter time to achieving sustained remission (HR 1.30; 95% CI 1.01 to 1.67) and experienced significantly higher improvements compared with ACPA/RF patients.

Conclusions: Combined ACPA and RF positivity were associated with improved and faster response to antirheumatic medications in patients with RA.

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Source
http://dx.doi.org/10.1136/rmdopen-2018-000738DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6241994PMC
November 2018
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