Improved RA classification among early arthritis patients with the concordant presence of three RA autoantibodies: analysis in two early arthritis clinics
Abstract Background The patients with RA benefit from early identification soon after the first clinical symptoms appear. The 2010 ACR/EULAR classification criteria were developed to fulfill this need and their application has been demonstrated to be effective. However, there is still room for impro...
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doaj-318f3261d0e94e3fb9e23670b1740da12020-12-13T12:40:39ZengBMCArthritis Research & Therapy1478-63622019-12-012111710.1186/s13075-019-2079-4Improved RA classification among early arthritis patients with the concordant presence of three RA autoantibodies: analysis in two early arthritis clinicsCristina Regueiro0Lorena Rodríguez-Martínez1Laura Nuño2Ana M. Ortiz3Alejandro Villalba4Dora Pascual-Salcedo5Ana Martínez-Feito6Isidoro González-Alvaro7Alejandro Balsa8Antonio Gonzalez9Experimental and Observational Rheumatology and Rheumatology Unit, Instituto de Investigacion Sanitaria-Hospital Clínico Universitario de Santiago (IDIS)Experimental and Observational Rheumatology and Rheumatology Unit, Instituto de Investigacion Sanitaria-Hospital Clínico Universitario de Santiago (IDIS)Rheumatology Department, Instituto de Investigación Hospital Universitario La Paz (IDIPAZ)Rheumatology Department, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria la Princesa (IIS-lP)Rheumatology Department, Instituto de Investigación Hospital Universitario La Paz (IDIPAZ)Rheumatology Department, Instituto de Investigación Hospital Universitario La Paz (IDIPAZ)Immuno-Rheumatology Department, Instituto de Investigación Hospital Universitario La Paz (IDIPAZ)Rheumatology Department, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria la Princesa (IIS-lP)Rheumatology Department, Instituto de Investigación Hospital Universitario La Paz (IDIPAZ)Experimental and Observational Rheumatology and Rheumatology Unit, Instituto de Investigacion Sanitaria-Hospital Clínico Universitario de Santiago (IDIS)Abstract Background The patients with RA benefit from early identification soon after the first clinical symptoms appear. The 2010 ACR/EULAR classification criteria were developed to fulfill this need and their application has been demonstrated to be effective. However, there is still room for improvement. Therefore, we aimed to evaluate the potential of the concordant presence of RF, anti-CCP and anti-carbamylated protein antibodies to improve current RA classification among early arthritis (EA) patients. Methods Data from the first visit of 1057 patients in two EA prospective cohorts were used. The serological scores from the 2010 ACR/EULAR criteria and the concordant presence of the three RA autoantibodies were assessed relative to a gold standard consisting of the RA classification with the 1987 ACR criteria at the 2 years of follow-up. Results The concordant presence of three antibodies showed predictive characteristics allowing for direct classification as RA (positive predictive value = 96.1% and OR = 80.9). They were significantly better than the corresponding to the high antibody titers defined as in the 2010 classification criteria (PPV = 88.8%, OR = 26.1). In addition, the concordant presence of two antibodies was also very informative (PPV = 82.3%, OR = 15.1). These results allowed devising a scoring system based only on antibody concordance that displayed similar overall performance as the serological scoring system of the 2010 criteria. However, the best classification was obtained combining the concordance and 2010 serological systems, a combination with a significant contribution from each of the two systems. Discussion The concordant presence of RA autoantibodies showed an independent contribution to the classification of EA patients that permitted increased discrimination and precision.https://doi.org/10.1186/s13075-019-2079-4Rheumatoid arthritisEarly arthritisDisease classificationAutoantibodiesRheumatoid factorAnti-citrullinated protein antibodies |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Cristina Regueiro Lorena Rodríguez-Martínez Laura Nuño Ana M. Ortiz Alejandro Villalba Dora Pascual-Salcedo Ana Martínez-Feito Isidoro González-Alvaro Alejandro Balsa Antonio Gonzalez |
spellingShingle |
Cristina Regueiro Lorena Rodríguez-Martínez Laura Nuño Ana M. Ortiz Alejandro Villalba Dora Pascual-Salcedo Ana Martínez-Feito Isidoro González-Alvaro Alejandro Balsa Antonio Gonzalez Improved RA classification among early arthritis patients with the concordant presence of three RA autoantibodies: analysis in two early arthritis clinics Arthritis Research & Therapy Rheumatoid arthritis Early arthritis Disease classification Autoantibodies Rheumatoid factor Anti-citrullinated protein antibodies |
author_facet |
Cristina Regueiro Lorena Rodríguez-Martínez Laura Nuño Ana M. Ortiz Alejandro Villalba Dora Pascual-Salcedo Ana Martínez-Feito Isidoro González-Alvaro Alejandro Balsa Antonio Gonzalez |
author_sort |
Cristina Regueiro |
title |
Improved RA classification among early arthritis patients with the concordant presence of three RA autoantibodies: analysis in two early arthritis clinics |
title_short |
Improved RA classification among early arthritis patients with the concordant presence of three RA autoantibodies: analysis in two early arthritis clinics |
title_full |
Improved RA classification among early arthritis patients with the concordant presence of three RA autoantibodies: analysis in two early arthritis clinics |
title_fullStr |
Improved RA classification among early arthritis patients with the concordant presence of three RA autoantibodies: analysis in two early arthritis clinics |
title_full_unstemmed |
Improved RA classification among early arthritis patients with the concordant presence of three RA autoantibodies: analysis in two early arthritis clinics |
title_sort |
improved ra classification among early arthritis patients with the concordant presence of three ra autoantibodies: analysis in two early arthritis clinics |
publisher |
BMC |
series |
Arthritis Research & Therapy |
issn |
1478-6362 |
publishDate |
2019-12-01 |
description |
Abstract Background The patients with RA benefit from early identification soon after the first clinical symptoms appear. The 2010 ACR/EULAR classification criteria were developed to fulfill this need and their application has been demonstrated to be effective. However, there is still room for improvement. Therefore, we aimed to evaluate the potential of the concordant presence of RF, anti-CCP and anti-carbamylated protein antibodies to improve current RA classification among early arthritis (EA) patients. Methods Data from the first visit of 1057 patients in two EA prospective cohorts were used. The serological scores from the 2010 ACR/EULAR criteria and the concordant presence of the three RA autoantibodies were assessed relative to a gold standard consisting of the RA classification with the 1987 ACR criteria at the 2 years of follow-up. Results The concordant presence of three antibodies showed predictive characteristics allowing for direct classification as RA (positive predictive value = 96.1% and OR = 80.9). They were significantly better than the corresponding to the high antibody titers defined as in the 2010 classification criteria (PPV = 88.8%, OR = 26.1). In addition, the concordant presence of two antibodies was also very informative (PPV = 82.3%, OR = 15.1). These results allowed devising a scoring system based only on antibody concordance that displayed similar overall performance as the serological scoring system of the 2010 criteria. However, the best classification was obtained combining the concordance and 2010 serological systems, a combination with a significant contribution from each of the two systems. Discussion The concordant presence of RA autoantibodies showed an independent contribution to the classification of EA patients that permitted increased discrimination and precision. |
topic |
Rheumatoid arthritis Early arthritis Disease classification Autoantibodies Rheumatoid factor Anti-citrullinated protein antibodies |
url |
https://doi.org/10.1186/s13075-019-2079-4 |
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