How to Recruit Anti-CCP Positive Patients from Primary Care

Jackie L. Nam¹, Laura Hunt¹, Elizabeth M.A. Hensor¹ and Paul Emery^1,2, ¹NIHR-Leeds Musculoskeletal Biomedical Research Unit and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom, ²Division of Rheumatic and Musculoskeletal Disease, University of Leeds, Leeds Institute of Molecular Medicine and LMBRU, Leeds, United Kingdom

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: ACPA, anti-CCP antibodies, inflammatory arthritis, primary care and rheumatoid arthritis (RA)

Session Information

Date: Sunday, November 8, 2015

Title: Rheumatoid Arthritis - Clinical Aspects Poster I

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose:

Around 1% of the population test positive for anti-cyclic citrullinated peptide (anti-CCP) antibodies. This biomarker predicts progression to rheumatoid arthritis (RA) but over a variable time-frame. To increase its clinical relevance, this study sought to determine (1) if the proportion of anti-CCP positive individuals could be enriched by case selection of people attending primary care with new nonspecific musculoskeletal (MSK) symptoms but without clinical synovitis (CS) and (2) whether these individuals progress rapidly to inflammatory arthritis (IA), in particular RA.

Methods:

In this prospective cohort study, individuals aged ≥18 years with new nonspecific MSK symptoms, without CS, were recruited from primary care in the U.K. Anti-CCP positive individuals were invited for follow-up in the rheumatology department, Leeds. Those who tested negative were sent questionnaires 12 months later.

Results:

2028 individuals were recruited. Of the 2.8% (57/2028) who were anti-CCP positive, 47% (27/57) developed IA [24 RA; 1 undifferentiated IA (UIA); 2 polymyositis]; 92.6% (25/27) within 12 months, [median (IQR) 1.8 (1.0-4.3) months, range 0.3 to 16.1]. Of the anti-CCP negative individuals, 1.3% (20/1559) developed IA (13 RA; 1 UIA; 6 psoriatic arthritis); 75% (15/20) within 12 months. The RR for developing RA within 12 months in the anti-CCP positive group was 66.8 (32.2-138.4, p<0.001); for IA it was 45.5 (95%CI 25.4-81.6, p<0.001).

Conclusion:

Selecting individuals with new nonspecific MSK symptoms without CS enriched the prevalence of anti-CCP positivity to 2.8%. Those who tested positive had a high risk of rapidly developing RA. The cost effectiveness of this approach will need to be determined.

Disclosure: J. L. Nam, None; L. Hunt, None; E. M. A. Hensor, None; P. Emery, Pfizer, MSD, AbbVie, UCB, Roche, Bristol-Myers Squibb, 5.

To cite this abstract in AMA style:

Nam JL, Hunt L, Hensor EMA, Emery P. How to Recruit Anti-CCP Positive Patients from Primary Care [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/how-to-recruit-anti-ccp-positive-patients-from-primary-care/. Accessed .

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