Serial determination of cyclic citrullinated peptide autoantibodies predicted five-year radiological outcomes in a prospective cohort of patients with early rheumatoid arthritis

Arthritis Res Ther. 2006;8(2):R40. doi: 10.1186/ar1896. Epub 2006 Jan 26.


The objective of this study was to evaluate the potential of serially determined anti-cyclic citrullinated peptide (CCP) antibodies for predicting structural joint damage in patients with early rheumatoid arthritis (RA), compared to a single baseline determination. Ninety-nine RA patients with disease durations of less than one year and no history of disease-modifying antirheumatic drug therapy were followed prospectively for at least five years. Anti-CCP2 concentrations were measured using a second-generation ELISA. Sharp scores as modified by van der Heijde were determined on hand and foot radiographs. Anti-CCP2 antibodies were detected in 55.5% of patients at baseline and 63.6% at any time during the first three years. Presence of anti-CCP2 at any time during the first three years was associated with radiographic damage at baseline (odds ratio (OR), 3.66; 95% confidence interval (95% CI) 0.99-13.54) and with five year progression of the total Sharp score (OR, 3.17; 95% CI, 1.3-7.7), erosion score (OR, 5.3; 95% CI, 1.4-19.2) and joint space narrowing score (OR, 2.8; 95% CI, 1.15-6.8). The presence of anti-CCP2 or IgM RF at baseline did not predict these outcomes. Patients with negative anti-CCP2 tests throughout follow-up had less radiographic progression than patients with increasing anti-CCP2 concentrations; they did not differ from patients with decreasing anti-CCP2 antibody levels. HLADRB1* typing showed that progression of the mean modified Sharp score was not correlated with the presence of the shared epitope alleles. In conclusion, serially determined anti-CCP2 antibodies during the first three years of follow-up performs better than baseline determination for predicting radiographic progression in patients with early RA.

MeSH terms

  • Arthritis, Rheumatoid / diagnostic imaging*
  • Arthritis, Rheumatoid / immunology*
  • Arthrography*
  • Autoantibodies / blood*
  • Cohort Studies
  • Disease Progression
  • Female
  • Foot / diagnostic imaging
  • Hand / diagnostic imaging
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Osmolar Concentration
  • Peptides, Cyclic / immunology*
  • Predictive Value of Tests
  • Prospective Studies


  • Autoantibodies
  • Peptides, Cyclic
  • cyclic citrullinated peptide