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RA risk increased up to fivefold among patients with high CCP levels
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Among patients who are cyclic citrullinated peptide antibody positive, the risk for rheumatoid arthritis significantly increases as the level of antibodies rise, according to data published in Arthritis Care & Research.
“Previous studies have demonstrated presence of RA-specific antibodies like cyclic citrullinated peptide antibody (CCP) in the serum several years prior to RA onset,” Julia A. Ford, MD, of Brigham and Women’s Hospital and Harvard Medical School, and colleagues wrote. “To date, much of what is known about CCP-positive individuals without classifiable RA comes from blood bank studies, studies of unaffected family members of patients with RA, and cohort studies of patients recruited from European arthralgia clinics.”
To evaluate the risk for RA among patients who are CCP-positive, but without RA at initial presentation, Ford and colleagues conducted a retrospective cohort study of 340 adult participants who were seen at Partners HealthCare, a tertiary health care system in Boston, between 2009 and 2018.
Patients were excluded if they had a diagnosis of RA, systemic lupus erythematosus, scleroderma, spondyloarthritis, antiphospholipid syndrome, mixed connective tissue disease, Sjögren’s syndrome, systemic vasculitis, polymyalgia rheumatica, dermatomyositis, polymyositis or juvenile idiopathic arthritis at the time of CCP positivity.
The researchers determined the development of RA was using medical record review. In addition, they analyzed the overall risk for RA, stratified by CCP level. These levels were defined as low — one to two times upper limit of normal; medium — two to three times the normal upper limit; or high — greater than three times the upper limit of normal. The researchers used multivariable Cox regression to estimate the hazard ratio and confidence interval for RA by CCP level.
In an interview with Healio Rheumatology, Ford noted that “CCP level at baseline was strongly associated with risk of progressing to RA, with high level CCP conferring a nearly fivefold increased risk of RA compared to low level CCP.”
According to the researchers, during 1,047 personyears of followup, 21.5% of participants developed RA, with 46% (95% CI, 34.755.3) of participants with high CCP levels developing RA within 5 years. After adjusting for age, sex, BMI, smoking, family history of RA, and rheumatoid factor level, medium (HR = 3; 95% CI, 1.326.81) and high (HR = 4.83; 95% CI, 2.519.31) levels of CCP were strongly associated with developing RA, compared with low levels.
“As clinicians, many of us have encountered a patient who is found to be CCP positive but does not meet criteria for RA,” Ford told Healio Rheumatology. “Our findings provide information for clinicians on how to discuss risk of progression to RA with these patients.” – by Jason Laday
Disclosure: Ford reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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