Different properties of ACPA and IgM-RF derived from a large dataset: further evidence of two distinct autoantibody systems

Arthritis Res Ther. 2009;11(3):R75. doi: 10.1186/ar2704. Epub 2009 May 21.


Introduction: The aim of this study was to examine seroconversion and the relationship with age and inflammation of autoantibodies in a large group of patients attending an outpatient rheumatology clinic.

Methods: Levels of antibodies to citrullinated proteins/peptides (ACPAs) and IgM rheumatoid factor (IgM-RF) were determined in 22,427 samples collected from 18,658 patients. The diagnosis was derived from a diagnosis registration system. The degree of seroconversion in repeated samples and the correlation of levels with age and inflammatory markers were determined for ACPA and IgM-RF in rheumatoid arthritis (RA) and non-RA patients.

Results: Seventy-one percent of RA patients (n = 1,524) were ACPA-positive and 53% were IgM-RF-positive; in non-RA patients (n = 2,245), the corresponding values were 2% and 4%, respectively. In patients with at least two samples (n = 3,769), ACPA status was more stable than IgM-RF status in RA patients. ACPA- or IgM-RF-negative non-RA patients seldom became positive. ACPA positivity was unrelated to age in both RA and non-RA patients. IgM-RF positivity was unrelated to age in RA patients; however, it increased with age in non-RA patients. The correlation between autoantibody levels and inflammatory markers was low in general and was somewhat higher for IgM-RF than for ACPA.

Conclusions: ACPA status is more stable in time and with increasing age than IgM-RF status, further establishing its role as a disease-specific marker. ACPA and IgM-RF levels are only moderately correlated with markers of inflammation.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Arthritis, Rheumatoid / blood
  • Arthritis, Rheumatoid / diagnosis
  • Arthritis, Rheumatoid / immunology
  • Autoantibodies / biosynthesis
  • Autoantibodies / blood*
  • Biomarkers / blood
  • Citrulline / blood*
  • Citrulline / immunology
  • Databases, Factual*
  • Female
  • Humans
  • Immunoglobulin M / biosynthesis
  • Immunoglobulin M / blood*
  • Male
  • Middle Aged
  • Rheumatoid Factor / biosynthesis
  • Rheumatoid Factor / blood*


  • Autoantibodies
  • Biomarkers
  • Immunoglobulin M
  • Citrulline
  • Rheumatoid Factor