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The Predictive Value of Rheumatoid Factor Isotypes, Anti-Cyclic Citrullinated Peptide Antibodies, and Antineutrophil Cytoplasmic Antibodies for Mortality in Patients with Rheumatoid Arthritis
SUSANNA SIHVONEN, MARKKU KORPELA, ANU MUSTILA, and JUKKA MUSTONEN
ABSTRACT.
Objective. To evaluate the significance of rheumatoid factor (RF) and its isotypes (IgA RF, IgG RF, and IgM RF), anti-cyclic citrullinated peptide antibodies (anti-CCP), and antineutrophil cytoplasmic antibodies (ANCA) in predicting mortality in patients with rheumatoid arthritis (RA). Methods. The study population comprised 604 patients with RA participating in a cross-sectional study in 1987. Presence of RF (n = 604), RF isotypes (n = 206), anti-CCP (n = 184), and ANCA (n = 200) were determined in these patients from available baseline sera. Vital status was assessed in 1999 and multivariate Cox regression analysis used to compare mortality in RA patients with or without different antibodies. Results. Of the 604 patients with RA, 55% were positive for RF, 66% for anti-CCP, and 14.5% for perinuclear ANCA. Twelve patients (19%) with RF were anti-CCP-negative and 34 (40%) without RF were anti-CCP-positive. Of the total 604 patients, 160 had died by 1999. Positive RF and high IgA and IgM RF levels predicted increased mortality, while positive anti-CCP or ANCA did not. However, high anti-CCP levels were related to an increased mortality risk. Conclusion. Patients with RA with positive RF, especially IgA and IgM isotypes, carry a risk of dying earlier than patients without these serological findings. (J Rheumatol 2005;32:2089-94) Key Indexing Terms:
RHEUMATOID ARTHRITIS From the Department of Internal Medicine and Centre for Laboratory Medicine, Department of Clinical Microbiology, Tampere University Hospital, and the University of Tampere Medical School, Tampere, Finland. Supported by grants from the Medical Research Fund of Tampere University Hospital and the Finnish Cultural Foundation (Regional Fund of Pirkanmaa). S. Sihvonen, MD; M. Korpela, MD, PhD, Department of Internal Medicine, Tampere University Hospital; A. Mustila, MD, PhD, Centre for Laboratory Medicine, Tampere University Hospital; J. Mustonen, MD, PhD, University of Tampere. Address reprint requests to Dr. S. Sihvonen, Department of Internal Medicine, Tampere University Hospital, PO Box 2000, Fin-33521, Tampere, Finland. E-mail: susanna.sihvonen@fimnet.fi Accepted for publication June 26, 2005. |