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For patients withrheumatoid arthritis (RA), rheumatoid factor (RF) and anti-citrullinatedprotein antibodies (ACPA) demonstrate different isotype patterns during diseasedevelopment, according to results published in Arthritis & Rheumatology.

The study included participants with RA (n=214) and matched control participants (n=210) from the Department of Defense Serum Repository. The researchers tested a mean of 3 pre-RA and 1 post-RA serum samples for RF and ACPA immunoglobulin (Ig) A, IgG, and IgM. They then evaluated the timing and trajectories of autoantibody elevations.

Compared withcontrol individuals, participants with RA had significant differences in RF-IgAlevels at a median of 14.2 years before diagnosis (P <.01).Differences in RF-IgG occurred at 5.0 years, and differences in RF-IgM levelsoccurred at 7.2 years (both P <.01).

Participants with RAhad significantly different levels of ACPA IgG at 17.9 years before RAdiagnosis compared with control individuals (P <.01). For ACPA-IgA,the difference occurred at 6.2 years, and for ACPA-IgM, it differed at 5.0years (both P <.01).

After RA diagnosis,the only autoantibody that had a significant positivity increase was ACPA-IgA(19% 0-2 years pre-RA vs. 39% >2 years post-RA, P =.04).

The resultsindicated that among participants with RA, all autoantibodies followed asimilar trajectory, with an early initial elevation, a period of stability, andan immediate increase pre-RA diagnosis.

The study includedseveral limitations. The researchers noted that the military cohort used in thestudy may have a more severe form of RA than other populations. In addition,delays in seeking treatment may mean that the actual time of synovitis onset isearlier than the date of diagnosis.

These findingshave implications for understanding the pathophysiology of disease development,the researchers wrote.

Disclosure: Severalstudy authors declared affiliations with the pharmaceutical industry. Pleasesee the original reference for a full list of authors disclosures.

Reference

Kelmenson LB, Wagner BD, McNair BK, et al. Timing of elevations of autoantibody isotypes in rheumatoid arthritis prior to disease diagnosis [published online August 29, 2019]. Arthritis Rheumatol. doi:10.1002/art.41091

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Variance in Isotype Patterns Before Rheumatoid Arthritis Diagnosis - Rheumatology Advisor

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