The impact of autoantibodies against citrullinated, carbamylated, and acetylated peptides on radiographic progression in patients with new-onset rheumatoid arthritis: an observational cohort study

Nijjar, J. S., Morton, F. R. , Bang, H., Buckley, C. D., van der Heijde, D., Gilmour, A., Paterson, C., McInnes, I. B. , Porter, D. and Raza, K. (2021) The impact of autoantibodies against citrullinated, carbamylated, and acetylated peptides on radiographic progression in patients with new-onset rheumatoid arthritis: an observational cohort study. Lancet Rheumatology, 3(4), e284-e293. (doi: 10.1016/S2665-9913(20)30381-7) (PMID:34604794) (PMCID:PMC7611758)

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Abstract

Background: A range of anti-modified protein antibodies (AMPAs) are associated with rheumatoid arthritis. We aimed to assess the relationship between AMPA profiles and radiographic progression in patients with new-onset rheumatoid arthritis. Methods: In this cohort study, we obtained samples and data from the Scottish Early Rheumatoid Arthritis (SERA) inception cohort and biobank, which recruited patients with new-onset rheumatoid arthritis or undifferentiated arthritis who had at least one swollen joint from 20 hospitals across Scotland. AMPAs in plasma samples were measured by ELISAs at baseline. Paired radiographs of the hands and feet were taken at baseline and at 1 year and were scored with the Sharp-van der Heijde (SvH) method. We calculated differences in radiographic progression using estimated marginal mean changes between baseline and 1 year, with the baseline values of radiographic variables, rheumatoid factor, sex, age at recruitment, symptom duration, and Disease Activity Score 28 with C-reactive protein included as covariates. Findings: Between March 1, 2011, and April, 30, 2015, 1073 patients were recruited to the SERA study. 362 patients with rheumatoid arthritis were included in our study and had their AMPA profiles determined. Patients were grouped into four main autoantibody profiles by reactivities to post-translational modifications: single positivity for anti-citrullinated peptide antibodies (ACPAs; 73 [20%]); double positivity for ACPAs and anti-acetylated peptide antibodies (AAPAs; 45 [12%]); triple positivity for ACPAs, AAPAs, and anti-carbamylated peptide antibodies (151 [42%]); and AMPA negativity (74 [20%]). 19 (5%) patients were in one of the minor autoantibody groups. Of the 233 patients with both antibody data and radiographs of sufficient quality, triple-positive patients had more radiographic progression between baseline and 12 months (estimated mean change in total SvH score 1·8, 95% CI 0·9–2·6, SE 0·4) than did single-positive patients (0·5, 0·1–1·0, 0·2; estimated mean difference in the total change in SvH score 1·2, 95% CI 0·1–2·4, SE 0·5). There was no difference in radiographic progression between single positive patients and AMPA negative patients (estimated mean change in total SvH score 0·7, 95% CI 0·1–1·4, SE 0·3; estimated mean difference in the total change in SvH score −0·2, 95% CI −1·1 to 0·7, SE 0·4). Interpretation: This study suggests that the optimal prediction of future rates of radiographic progression in patients with rheumatoid arthritis will require an assessment of autoantibodies against multiple post-translationally modified proteins or peptides. Funding: The EU FP7 HEALTH programme, the Scottish Translational Medicine Research Collaboration, and the Chief Scientist Office Scotland.

Item Type:Articles
Additional Information:Funding: EU FP7 HEALTH programme, Scottish Translational Medicine Research Collaboration, Scottish Chief Scientific Office.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McInnes, Professor Iain and Porter, Dr Duncan and Gilmour, Miss Ashley and Morton, Mr Fraser and Paterson, Miss Caron
Authors: Nijjar, J. S., Morton, F. R., Bang, H., Buckley, C. D., van der Heijde, D., Gilmour, A., Paterson, C., McInnes, I. B., Porter, D., and Raza, K.
College/School:College of Medical Veterinary and Life Sciences > School of Infection & Immunity
Research Centre:College of Medical Veterinary and Life Sciences > School of Infection & Immunity > Centre for Immunobiology
Journal Name:Lancet Rheumatology
Publisher:Elsevier
ISSN:2665-9913
ISSN (Online):2665-9913
Published Online:27 January 2021
Copyright Holders:Copyright © 2020 Elsevier Ltd.
First Published:First published in Lancet Rheumatology 3(4):e284-e293
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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