Background/Purpose: Does anti-CCP-positivity predict disease course and response to therapy in early rheumatoid arthritis (RA)?

Methods: We retrieved clinical follow-up data for patients entering the EIRA cohort 1996-2009 from the Swedish Rheumatology Quality Register (1996-2010). Overall, 1,640 of the 2,567 registered RA patients were followed from diagnosis. Then, 99 received no DMARD treatment, 41 received only prednisolone, 670 only methotrexate, 476 methotrexate and prednisolone, 224 sulfasalazine, whereas 130 patients received other DMARDs or combinations. The association between anti-CCP-positivity and EULAR good response was evaluated by logistic regression and expressed as univariate p-values and multivariate odds ratios (OR) with 95% confidence intervals (CI), adjusted for gender, age, inclusion year, symptom duration, HAQ score and cigarette smoking habits. 

Results:

The proportion starting DMARD/methotrexate at diagnosis increased during the inclusion period (p<0.0001/<0.0001). In the subgroup receiving no DMARD, anti-CCP-positive patients were, compared to anti-CCP-negative patients, less likely to fulfil the criteria for ‘good response’ after 3 months (15% vs. 48%, p=0.002; adjusted odds ratio=0.24; 95%CI 0.07-0.82). A smaller, but significant difference was observed between anti-CCP-positive and anti-CCP-negative patients receiving methotrexate only (31% vs. 41%, p=0.02; adjusted odds ratio=0.65; 95%CI 0.44-0.94), whereas no difference was observed between anti-CCP-positive and anti-CCP-negative patients receiving both methotrexate and prednisolone (52% vs. 49%, p=0.5; adjusted odds ratio=1.23; 95%CI 0.78-1.92). No significant differences were observed in patients receiving sulfasalazine or in the entire cohort during 2 years follow-up.

Conclusion: Anti-CCP positivity predicts persistent disease activity in early RA patients not receiving DMARD treatment, while its predictive value for response is limited in patients treated with MTX, SSZ and prednisolone, and in the entire group of RA patients reflecting all treatment options over time. Our findings also indicate that the less chance of a favorable clinical disease course in anti-CCP positive patients may be compensated for with treatment, namely that today´s standard care with methotrexate and low dose prednisolone may have its main effects in ACPA-positive patients. This highlights the importance of performing a careful subgrouping of the RA syndrome in all controlled as well as observational studies on drug treatment.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/predictive-value-of-anti-ccp-positivity-on-disease-course-and-response-to-therapy-in-early-rheumatoid-arthritis-results-from-the-swedish-eira-study/