Session Information
Date: Monday, October 22, 2018
Title: Rheumatoid Arthritis – Diagnosis, Manifestations, and Outcomes Poster II: Diagnosis and Prognosis
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose:
Joint pain is a common extra-hepatic manifestation of chronic hepatitis C (HCV) infection. HCV infection is often associated with the presence of autoantibodies such as rheumatoid factor (RF), seen in approximately 50% of patients, and anti-nuclear antibodies (ANA). Consequently, it can be difficult to distinguish HCV arthralgias from rheumatoid arthritis (RA), especially in early RA when erosions or joint space narrowing are often lacking. Recent studies suggest that antibodies to cyclic citrullinated peptides (anti-CCP antibodies) are highly specific for RA and are absent in patients with HCV arthralgias. In this study, we determined the sensitivity, specificity, and positive and negative predictive values of RF and anti-CCP antibodies for RA in patients with HCV arthralgias.
Methods:
We enrolled 97 patients with HCV and arthralgias (defined as pain in >3 joints) in this St. Louis VA Medical Center-based cross-sectional study. Patients were classified as HCV with RA (RA+) or HCV without RA (RA-) based on the presence of HCV antibodies, HCV RNA, or consistent liver biopsy, and meeting 1987 ACR criteria for the diagnosis of RA. Demographic, clinical and serologic information was collected on all patients during a standardized in-person medical evaluation. Patients were excluded if they had other major autoimmune extrahepatic manifestations of HCV (vasculitis, glomerulonephritis, monoclonal gammopathy, lymphoma or multiple myeloma) or were on current anti-viral treatment for HCV infection. Categorical and continuous variables were analyzed using Fisher’s exact test and t-tests respectively. A two-sided p-value < 0.05 demonstrated statistical significance.
Results:
Of the 97 patients with HCV and polyarthralgias, 17 met ACR criteria for RA (HCV RA+) and 80 had arthralgias from non-RA causes (HCV RA-): HCV arthralgia (31), osteoarthritis (28), crystalline arthropathy (9), spondyloarthropathy (7), fibromyalgia (3), polymyalgia rheumatica (2). Both groups were predominantly male (94.1% and 88.8%) and mainly consisted of African Americans in the HCV RA+ group (64.7%) and Caucasians in the HCV RA- group (50%). In the HCV RA+ group, 94.1% had synovitis, while only 6.9% of HCV RA- patients did. RF was the most sensitive (100%) serology, while anti-CCP was highly specific (98.8%). Anti-CCP antibodies exhibited high positive and negative predictive values, 94.1% and 98.8% respectively. Synovitis had a high negative predictive value of 98.6%.
Conclusion:
The presence of anti-CCP antibodies and synovitis is highly specific for the diagnosis of RA in patients with HCV arthralgias.
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Table 1: Demographic and clinical characteristics of 97 patients with HCV arthralgias with and without RA |
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Characteristics |
HCV arthralgia with RA (n=17) |
HCV arthralgia P value without RA (n=80)
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Age Female Caucasian AM stiffness (>30mins) Symmetrical joints Hand involvement Synovitis Radiographic erosions Positive RF Positive Anti-CCP Positive ANA |
57.2 1 (5.9%) 6 (32.3%) 13 (92.9%) 17 (100%) 16 (94.1%) 16 (94.1%) 7 (41.2%) 17 (100%) 16 (94.1%) 9 (52.9%) |
55.2 0.26 9 (11.3%) 1.00 40 (50.0%) 0.60 32 (42.7%) 0.0008 59 (76.6%) 0.036 49 (63.6%) 0.018 5 (6.9%) 0.00001 4 (5.3%) 0.0004 53 (69.7%) 0.009 1 (1.3%) 0.00001 14 (18.0%) 0.0046
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Anti-CCP-Anti cyclic citrullinated peptide antibody, RF-Rheumatoid factor, ANA-Antinuclear antibody |
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Table 2. Sensitivity, specificity, positive and negative predictive values of serologies and synovitis for RA, in 97 patients with HCV arthralgias |
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Sensitivity |
Specificity |
PPV |
NPV |
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RF Anti CCP antibody ANA Synovitis |
100% 94.1% 52.9% 94.1% |
33.8% 98.8% 80% 93.1% |
24.3% 94.1% 39.1% 76.2% |
100% 98.75% 88.89% 98.55% |
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ANA-Antinuclear antibody, RF-Rheumatoid factor, PPV-Positive predictive value, NPV-Negative Predictive value |
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To cite this abstract in AMA style:
Jayakumar D, Huang X, Eisen S, Ranganathan P, Joseph A. The Predictive Utility of Anti-Cyclic Citrullinated Peptide Antibodies to Diagnose Rheumatoid Arthritis in Patients with Hepatitis C and Polyarthralgias [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/the-predictive-utility-of-anti-cyclic-citrullinated-peptide-antibodies-to-diagnose-rheumatoid-arthritis-in-patients-with-hepatitis-c-and-polyarthralgias/. Accessed .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-predictive-utility-of-anti-cyclic-citrullinated-peptide-antibodies-to-diagnose-rheumatoid-arthritis-in-patients-with-hepatitis-c-and-polyarthralgias/