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Autoantibodies in Early Seropositive Rheumatoid Arthritis, Before and During Disease Modifying Antirheumatic Drug Treatment
HAROLD E. PAULUS, JASON WIESNER, KEN J. BULPITT, MADHUMITA PATNAIK, JACQUELINE LAW, GRACE S. PARK, and WENG KEE WONG, for the Western Consortium of Practicing Rheumatologists
ABSTRACT.
Method. The study cohort consisted of 276 patients with active RA and with RF ³ 40 IU, who were enrolled between January 1, 1993, and April 1, 2000, before starting disease modifying antirheumatic drug (DMARD) therapy (average duration of symptoms, 7 mo). During an average of 3.5 years followup, a panel of autoantibodies was determined at entry, 6 months, 12 months, and yearly thereafter, in addition to routine clinical, radiographic, and laboratory assessments. After enrollment, patients were treated with DMARD at the discretion of their rheumatologists. Results. At entry before any DMARD therapy, antinuclear antibody (ANA; by HEp-2) values were negative in 31%, borderline (8 IU/ml) in 26%, and > 8 (mean 65.5 IU/ml) in 41%. Tender and swollen joint counts, Disease Activity Score, and RF values were significantly higher in those with ANA > 8. During followup 726 paired serial specimens were available; 12.5% changed from negative to positive ANA and 12.3% from positive to negative. Additional autoantibodies were present in specimens of 20% of the subjects; 8% had 2 and 1.4% had 3 other autoantibodies. Anti-dsDNA was detected in 13 (5.5%) patients; 4 changed from negative to positive and one from positive to negative. SSA IgG and SSB IgG autoantibodies were both present in one of these patients. Ribosomal P protein autoantibodies were noted in 2 other patients, but Sm (Smith) and uRNP/snRNP IgG autoantibodies were not present in any patient. No patient had a diagnosis of systemic lupus erythematosus. Antithyroid peroxidase (20 patients), parietal cell (15), smooth muscle (14), reticulin (9), mitochondrial (5), striational (2), SSB (2) and SCL-70 (1) autoantibodies were detected in some specimens. Seven patients were diagnosed with hypothyroidism, one with chronic thyroiditis, one with hepatitis C, and 9 with malignancies. Conclusion. In patients with early RF positive RA the frequent occurrence of autoantibodies before and during treatment with standard DMARD may make it difficult to attribute their presence to new therapies. (J Rheumatol 2002;29:2513-20) Key Indexing Terms:
RHEUMATOID ARTHRITIS
From the Department of Medicine and the Department of Biostatistics, School of Public Health, University of California Los Angeles, Los Angeles, California; the Department of Medicine, University of Arizona at Tucson, Tucson, Arizona; and Specialty Laboratories Inc., Santa Monica, California, USA. Supported by NIH P60AR36834, Oregon Arthritis Foundation, and the Charlotte Mundt Fund. H.E. Paulus, MD, Professor of Medicine; K.J. Bulpitt, MD, Associate Professor of Medicine; J. Law, PhD, Biostatistician (currently Celera Diagnostis, Alameda, CA); G.S. Park, MPH, Biostatistician, Department of Medicine; W.K. Wong, PhD, Professor, Department of Biostatistics, School of Public Health, UCLA; J. Wiesner, MD, Resident, Department of Medicine, University of Arizona at Tucson, Tucson, AZ; M. Patnaik, MD, Director of Research, Specialty Laboratories Inc., Santa Monica, CA. Address reprint requests to Dr. H.E. Paulus, UCLA School of Medicine, 1000 Veteran Avenue, Room 32-59, Los Angeles, CA 90095. Submitted January 11, 2002; revision accepted June 10, 2002. |