Rheumatoid factor and anti-citrullinated protein antibody positivity, but not level, are associated with increased mortality in patients with rheumatoid arthritis: results from two large independent cohorts.

Jennifer H Humphreys, Jessica van Nies, Jackie Chipping, Tarnya Marshall, Annette Mil, Deborah Symmons, Suzanne Verstappen

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    Abstract

    IntroductionTo investigate rheumatoid factor (RF) and anti-citrullinated protein antibody (ACPA) status and levels as predictors of mortality in two large cohorts of patients with early inflammatory arthritis (EIA).MethodsData from the Norfolk Arthritis Register (NOAR) and Leiden Early Arthritis Clinic (EAC) cohorts were used. At baseline, patients had demographic data and smoking status recorded; RF, ACPA and inflammatory markers were measured in the local laboratories. Patients were flagged with national death registers until death or censor date. Antibody status was stratified as negative, low or high positive by RF and ACPA levels individually. In addition, patients were grouped as seronegative, RF positive, ACPA positive or double antibody (RF and ACPA) positive. Cox regression models explored associations between antibody status and mortality adjusting for age, sex, smoking status, inflammatory markers and year of enrolment.Results4962 (NOAR:3053, EAC:1909) patients were included, 64% were female. Median age at onset was 56 (NOAR) and 54 (EAC) years. 35% and 42% of patients were ACPA/RF positive in NOAR and EAC respectively. When antibody status was stratified as negative, low or high positive, there were no consistent findings between the two cohorts. Double antibody positivity was associated with excess mortality in both cohorts compared to seronegative patients: NOAR and EAC respective adjusted HR (95% CI): 1.35 (1.09-1.68) and 1.58 (1.16-2.15).ConclusionsPatients with EIA who are seropositive for both RF and ACPA have increased mortality compared to those who are single positive or seronegative. Antibody level in seropositive patients was not consistently associated with excess mortality.
    Original languageEnglish
    Article number483
    JournalArthritis Research & Therapy (Online)
    Volume16
    Issue number6
    DOIs
    Publication statusPublished - 4 Dec 2014

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