Association of Anti-cyclic Citrullinated Peptide Antibodies with Clinical and Radiological Disease Severity in Rheumatoid Arthritis
Rajeev M. Kaushik,
Objective: This study assessed an association of anti-cyclic citrullinated peptide antibodies
(ACPA) with clinical and radiological disease severity in patients with rheumatoid arthritis (RA).
Materials and Methods: Fifty patients diagnosed with RA as per 2010 revised American College of
Rheumatology/ European League Against Rheumatism (ACR/EULAR) classification criteria were included
in this cross-sectional study. Serum levels of ACPA, C-reactive protein (CRP) and rheumatoid factor
(RF), erythrocyte sedimentation rate (ESR), disease activity score with 28-joint counts and ESR
(DAS28-ESR), patient’s global assessment of disease activity using visual analogue scale (PtGA-VAS), modified health
assessment questionnaire score (M-HAQ) and radiological damage in hands and feet (modified Larsen score) were determined.
Results: ACPA were positive in 48 (96%) and RF in 44 (88%) patients. Mean Larsen score was 19.82 ± 17.11 and mean
DAS28-ESR 6.39 ± 1.59. A significant correlation of ACPA levels was seen with RF (p=0.03) and Larsen score (p=0.02)
but not with DAS28-ESR (p=0.17) and M-HAQ (p=0.81). A significant correlation was seen between Larsen score and
disease duration (p<0.0001), age (p=0.04), DAS28-ESR (p=0.001) and M-HAQ (p<0.0001). Multivariate analysis showed
that painful joint count (p=0.003), ESR (p<0.001) and PtGA-VAS (p=0.009) were independently associated with clinical
disease activity severity. Disease duration (p=0.01), ACPA levels (p=0.004) and DAS28-ESR (p=0.03) were independently
associated with radiological joint damage.
Conclusion: Serum ACPA levels correlate significantly with radiological severity of RA but not with clinical disease severity
and are independently associated with radiological outcome.
Keywords: Anti-cyclic citrullinated peptide antibodies, disease activity score, modified health assessment questionnaire score,
modified Larsen score, rheumatoid arthritis.
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