Dual antibody status predicts sustained remission in patients with rheumatoid arthritis
Background: Rheumatoid factor (RF) and anti-cyclic citrullinated protein (ACCP) estimation have been used to improve the diagnosis of rheumatoid arthritis (RA). However, their role in prognostication of RA, individually and in combination, is not well studied. This is, especially, true for Indian pa...
Saved in:
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2019-01-01
|
| Series: | Indian Journal of Rheumatology |
| Subjects: | |
| Online Access: | http://www.indianjrheumatol.com/article.asp?issn=0973-3698;year=2019;volume=14;issue=1;spage=32;epage=36;aulast=Jadhav |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849306585689489408 |
|---|---|
| author | Praveen Pratap Jadhav Jaya Dilip Avhad Mahendra Mahajan Asmanaz Mehemud Patel Hemant Ramchandra Gavli Janhavee Praveen Jadhav Vaibhav Khandelwal |
| author_facet | Praveen Pratap Jadhav Jaya Dilip Avhad Mahendra Mahajan Asmanaz Mehemud Patel Hemant Ramchandra Gavli Janhavee Praveen Jadhav Vaibhav Khandelwal |
| author_sort | Praveen Pratap Jadhav |
| collection | DOAJ |
| description | Background: Rheumatoid factor (RF) and anti-cyclic citrullinated protein (ACCP) estimation have been used to improve the diagnosis of rheumatoid arthritis (RA). However, their role in prognostication of RA, individually and in combination, is not well studied. This is, especially, true for Indian patients.
Methods: Consecutive 945 patients who had their RF and ACCP determined were included in the study. They were followed up for 3 months to 24 months. Swollen joint count, erythrocyte sedimentation rate, disease activity score 28 (DAS 28), and Indian version of Health Assessment Questionnaire (HAQ) were checked during each visit. They were treated with conventional disease-modifying agents (DMARDS).
Results: At presentation, patients with both antibodies positive had the most severe disease, while those with both antibodies negative had the least severe disease. Among discordant antibody status (one antibody positive and the other negative), patients with ACCP positivity presented with higher disease activity than with RF positivity. Patients with dual antibody positivity were much less likely to be in remission than with both negative antibodies. The percentage of patients in remission were 34.2, 29.5, 32.4, and 24.7, respectively, for RF−/ACCP−, ACCP+/RF−, ACCP−/RF+, and ACCP+/RF+. Both, ACCP (odds ratio [OR]: 0.76; 95% confidence interval [CI]: 0.74–0.78) and RF (OR: 0.68; 95% CI: 0.66–0.70) positivity were associated with lower odds of sustained remission (P < 0.05).
Conclusion: Dual antibody-positive status at presentation carries poor prognosis, higher disease activity, higher HAQ score, and lesser chance of remission in RA patients with conventional treatment. Patients with both antibodies negative status had the best prognosis. Although patients with discordant antibody status had an intermediate prognosis, the ones with ACCP had higher disease activity at follow-up. |
| format | Article |
| id | doaj-art-375796f984804e4d9dd74230758c86e3 |
| institution | Kabale University |
| issn | 0973-3698 0973-3701 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Indian Journal of Rheumatology |
| spelling | doaj-art-375796f984804e4d9dd74230758c86e32025-08-20T03:55:01ZengSAGE PublishingIndian Journal of Rheumatology0973-36980973-37012019-01-01141323610.4103/injr.injr_107_18Dual antibody status predicts sustained remission in patients with rheumatoid arthritisPraveen Pratap JadhavJaya Dilip AvhadMahendra MahajanAsmanaz Mehemud PatelHemant Ramchandra GavliJanhavee Praveen JadhavVaibhav KhandelwalBackground: Rheumatoid factor (RF) and anti-cyclic citrullinated protein (ACCP) estimation have been used to improve the diagnosis of rheumatoid arthritis (RA). However, their role in prognostication of RA, individually and in combination, is not well studied. This is, especially, true for Indian patients. Methods: Consecutive 945 patients who had their RF and ACCP determined were included in the study. They were followed up for 3 months to 24 months. Swollen joint count, erythrocyte sedimentation rate, disease activity score 28 (DAS 28), and Indian version of Health Assessment Questionnaire (HAQ) were checked during each visit. They were treated with conventional disease-modifying agents (DMARDS). Results: At presentation, patients with both antibodies positive had the most severe disease, while those with both antibodies negative had the least severe disease. Among discordant antibody status (one antibody positive and the other negative), patients with ACCP positivity presented with higher disease activity than with RF positivity. Patients with dual antibody positivity were much less likely to be in remission than with both negative antibodies. The percentage of patients in remission were 34.2, 29.5, 32.4, and 24.7, respectively, for RF−/ACCP−, ACCP+/RF−, ACCP−/RF+, and ACCP+/RF+. Both, ACCP (odds ratio [OR]: 0.76; 95% confidence interval [CI]: 0.74–0.78) and RF (OR: 0.68; 95% CI: 0.66–0.70) positivity were associated with lower odds of sustained remission (P < 0.05). Conclusion: Dual antibody-positive status at presentation carries poor prognosis, higher disease activity, higher HAQ score, and lesser chance of remission in RA patients with conventional treatment. Patients with both antibodies negative status had the best prognosis. Although patients with discordant antibody status had an intermediate prognosis, the ones with ACCP had higher disease activity at follow-up.http://www.indianjrheumatol.com/article.asp?issn=0973-3698;year=2019;volume=14;issue=1;spage=32;epage=36;aulast=JadhavAnti-cyclic citrullinated proteinprognosisremissionrheumatoid factor |
| spellingShingle | Praveen Pratap Jadhav Jaya Dilip Avhad Mahendra Mahajan Asmanaz Mehemud Patel Hemant Ramchandra Gavli Janhavee Praveen Jadhav Vaibhav Khandelwal Dual antibody status predicts sustained remission in patients with rheumatoid arthritis Indian Journal of Rheumatology Anti-cyclic citrullinated protein prognosis remission rheumatoid factor |
| title | Dual antibody status predicts sustained remission in patients with rheumatoid arthritis |
| title_full | Dual antibody status predicts sustained remission in patients with rheumatoid arthritis |
| title_fullStr | Dual antibody status predicts sustained remission in patients with rheumatoid arthritis |
| title_full_unstemmed | Dual antibody status predicts sustained remission in patients with rheumatoid arthritis |
| title_short | Dual antibody status predicts sustained remission in patients with rheumatoid arthritis |
| title_sort | dual antibody status predicts sustained remission in patients with rheumatoid arthritis |
| topic | Anti-cyclic citrullinated protein prognosis remission rheumatoid factor |
| url | http://www.indianjrheumatol.com/article.asp?issn=0973-3698;year=2019;volume=14;issue=1;spage=32;epage=36;aulast=Jadhav |
| work_keys_str_mv | AT praveenpratapjadhav dualantibodystatuspredictssustainedremissioninpatientswithrheumatoidarthritis AT jayadilipavhad dualantibodystatuspredictssustainedremissioninpatientswithrheumatoidarthritis AT mahendramahajan dualantibodystatuspredictssustainedremissioninpatientswithrheumatoidarthritis AT asmanazmehemudpatel dualantibodystatuspredictssustainedremissioninpatientswithrheumatoidarthritis AT hemantramchandragavli dualantibodystatuspredictssustainedremissioninpatientswithrheumatoidarthritis AT janhaveepraveenjadhav dualantibodystatuspredictssustainedremissioninpatientswithrheumatoidarthritis AT vaibhavkhandelwal dualantibodystatuspredictssustainedremissioninpatientswithrheumatoidarthritis |