Value of anti–modified citrullinated vimentin and third‐generation anti–cyclic citrullinated peptide compared with second‐generation anti–cyclic citrullinated peptide …
MPM van der Linden, D van der Woude… - … : Official Journal of …, 2009 - Wiley Online Library
MPM van der Linden, D van der Woude, A Ioan‐Facsinay, EWN Levarht…
Arthritis & Rheumatism: Official Journal of the American College …, 2009•Wiley Online LibraryObjective Autoantibodies such as rheumatoid factor (RF) and anti–citrullinated protein
autoantibodies (ACPAs) determined by testing with second‐generation anti–cyclic
citrullinated peptide (anti–CCP‐2) are frequently measured in clinical practice because of
their association with disease outcome in undifferentiated arthritis (UA) and rheumatoid
arthritis (RA). Recently, 2 new ACPA tests were developed: third‐generation anti‐CCP (anti–
CCP‐3) and anti–modified citrullinated vimentin (anti‐MCV) autoantibody tests. To facilitate …
autoantibodies (ACPAs) determined by testing with second‐generation anti–cyclic
citrullinated peptide (anti–CCP‐2) are frequently measured in clinical practice because of
their association with disease outcome in undifferentiated arthritis (UA) and rheumatoid
arthritis (RA). Recently, 2 new ACPA tests were developed: third‐generation anti‐CCP (anti–
CCP‐3) and anti–modified citrullinated vimentin (anti‐MCV) autoantibody tests. To facilitate …
Objective
Autoantibodies such as rheumatoid factor (RF) and anti–citrullinated protein autoantibodies (ACPAs) determined by testing with second‐generation anti–cyclic citrullinated peptide (anti–CCP‐2) are frequently measured in clinical practice because of their association with disease outcome in undifferentiated arthritis (UA) and rheumatoid arthritis (RA). Recently, 2 new ACPA tests were developed: third‐generation anti‐CCP (anti–CCP‐3) and anti–modified citrullinated vimentin (anti‐MCV) autoantibody tests. To facilitate the decision on which autoantibody to test in daily practice, this study evaluated the capability of these autoantibodies and combinations of them to predict 3 outcome measures: progression from UA to RA, the rate of joint destruction in RA, and the chance of achieving sustained disease‐modifying antirheumatic drug (DMARD)–free remission in RA.
Methods
Patients with UA (n = 625) were studied for whether UA progressed to RA after 1 year. Patients with RA (n = 687) were studied for whether sustained DMARD‐free remission was achieved and for the rate of joint destruction during a median followup of 5 years. Positive predictive values (PPVs) for RA development and for associations with the disease course in RA were compared between single tests (anti–CCP‐2, anti–CCP‐3, anti‐MCV, and RF) and between combinations of these tests.
Results
Among the single tests performed in patients with UA, anti–CCP‐2 tended to have the highest PPV for RA development (67.1%), but the 95% confidence intervals of the other tests overlapped. Among the single tests in patients with 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 compared with performing a single test.
Conclusion
For clinical practice, a single autoantibody test is sufficient for risk estimation in UA and RA.
Wiley Online Library