Dual rheumatoid factor and anti-cyclic citrullinated peptide antibody positivity affects the manifestations of rheumatoid arthritis.
10.4103/singaporemedj.SMJ-2021-104
- Author:
Li Huan Angela Marie CHAN
1
;
Khai Pang LEONG
2
;
Justina Wei Lynn TAN
2
;
Xiao GAO
2
;
Wei Qiang SEE
2
;
Ee Tzun KOH
2
Author Information
1. Division of Rheumatology, Department of General Medicine, Khoo Teck Puat Hospital, Singapore.
2. Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore.
- Collective Name:Tan Tock Seng Hospital Rheumatoid Arthritis Study Group
- Publication Type:Journal Article
- Keywords:
Anti-cyclic citrullinated peptide antibody;
rheumatoid arthritis;
rheumatoid factor
- MeSH:
Humans;
Arthritis, Rheumatoid/diagnosis*;
Male;
Female;
Middle Aged;
Rheumatoid Factor/blood*;
Anti-Citrullinated Protein Antibodies/blood*;
Adult;
Quality of Life;
Prospective Studies;
Antirheumatic Agents/therapeutic use*;
Aged;
Peptides, Cyclic/immunology*;
Prednisolone/therapeutic use*;
Surveys and Questionnaires;
Severity of Illness Index;
Prognosis
- From:Singapore medical journal
2025;66(9):486-491
- CountrySingapore
- Language:English
-
Abstract:
INTRODUCTION:Rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (ACPA) are used in the diagnosis and prognostication of rheumatoid arthritis (RA). We wanted to determine the specific contributions of RF and ACPA to the biological nature of RA and whether they act synergistically.
METHODS:We identified 731 patients from our prospective multi-ethnic RA cohort and categorised them into four groups: ACPA-positive, RF-positive, doubly positive and doubly negative. We compared the demographics, Disease Activity Score-28, Health Assessment Questionnaire score, quality of life using Short Form 36 and the use of prednisolone and disease-modifying antirheumatic drugs (DMARDs) of these patient groups.
RESULTS:Four hundred and ninety-one patients (67.2%) were ACPA+RF+, 54 (7.4%) were ACPA+RF-, 82 (11.2%) were ACPA-RF+ and 104 (14.2%) were ACPA-RF-. Mean disease duration before the study entry was not different in the four groups. Patients with older age of onset were less likely to be positive for RF and ACPA. Fewer ACPA+RF+ patients were in remission compared to those in the other groups ( P < 0.05). Erythrocyte sedimentation rate (ESR) was higher at study entry in the ACPA+RF+ group (40.4 mm/h vs. 30.6-30.9 mm/h, P < 0.05). Prednisolone and number of DMARDs used were higher in the ACPA+RF+ group compared to the doubly negative group. There were no differences in the functional status and quality of life.
CONCLUSIONS:RA patients who were positive for both ACPA and RF had lower remission rate, higher baseline ESR and required more corticosteroid and DMARD treatment compared to those who were singly positive or doubly negative. Being doubly positive confers a worse outcome to RA patients.
