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Repeat serological testing for anti‐citrullinated peptide antibody after commencement of therapy is not helpful in patients with seronegative rheumatoid arthritis
Author(s) -
Reid Alistair B.,
Wiese Michael,
McWilliams Leah,
Metcalf Rob,
Hall Cindy,
Lee Anita,
Hill Catherine,
Wechalekar Mihir,
Cleland Les,
Proudman Susanna M.
Publication year - 2020
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.14463
Subject(s) - medicine , seroconversion , rheumatoid arthritis , serology , rheumatoid factor , rheumatology , autoantibody , immunology , antibody , gastroenterology
Background Anti‐citrullinated peptide antibody (ACPA) and rheumatoid factor (RF) define ‘seropositive’ rheumatoid arthritis (RA). Both predict unfavourable disease course, development of extra‐articular features and treatment outcomes. We investigated the prevalence of seroconversion to ACPA after commencement of triple disease‐modifying anti‐rheumatic drug (DMARD) treat‐to‐target therapy. Aim To Investigate the prevalence of seroconversion to ACPA after commencement of triple DMARD treat‐to‐target therapy. Methods DMARD‐naïve patients with RA according to the 1987 American College of Rheumatology criteria and disease duration of <96 weeks were enrolled. RF and ACPA levels were recorded at baseline and sequentially during triple DMARD therapy. Results A total of 368 patients was followed for a median of 272 weeks. Of 154 patients seronegative for ACPA at recruitment, 10 (6.5%) seroconverted at some point. Nine of these were positive for RF at baseline and baseline RF titre was predictive of seroconversion. Four (2.6%) patients remained seropositive. No patients seroconverted from negative to positive for both RF and ACPA. Median time to seroconversion for ACPA was 29 months. Conclusion Persistent seroconversion of ACPA from negative to positive after diagnosis in patients with RA is uncommon. ACPA and RF double negative patients are highly unlikely ever to develop ACPA positivity with a risk <1%. It is therefore unlikely to be helpful or cost‐effective to perform serial ACPA measurements in patients with seronegative RA after commencement of a treat‐to‐target strategy.