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ObjectivesLittle is known about the likelihood of developing inflammatory arthritis (IA) in individuals who screen autoantibody positive (aAb+) in a non-clinical research setting.MethodsWe screened for serum cyclic citrullinated peptide antibody (anti-CCP) and rheumatoid factor isotype aAbs in subjects who were at increased risk for rheumatoid arthritis (RA) because they are a first-degree relative of an individual with classified RA (n=1780). We evaluated combinations of aAbs and high titre aAbs, as defined by 2-times (2 x) the standard cut-off and an optimal cut-off, as predictors of our two outcomes, aAb+ persistence and incident IA.Results304 subjects (17.1%) tested aAb+; of those, 131 were IA-free and had at least one follow-up visit. Sixty-four per cent of these tested aAb+ again on their next visit. Anti-CCP+ at levels ≥2 x the standard cut-off was associated with 13-fold higher likelihood of aAb +persistence. During a median of 4.4 years (IQR: 2.2–7.2), 20 subjects (15.3%) developed IA. Among subjects that screened anti-CCP+ at ≥ 2 x or ≥an optimal cut-off, 32% and 26% had developed IA within 5 years, respectively. Both anti-CCP cut-offs conferred an approximate fourfold increased risk of future IA (HR 4.09 and HR 3.95, pConclusionsThese findings support that aAb screening in a non-clinical setting can identify RA-related aAb+ individuals, as well as levels and combinations of aAbs that are associated with higher risk for future IA. Monitoring for the development of IA in aAb+ individuals and similar aAb testing approaches in at-risk populations may identify candidates for prevention studies in RA.

It was with interest that we read the article by Belkhir et al 1 in the recent Annals of Rheumatic Disease . The article described the first report of rheumatoid arthritis (RA) and polymyalgia rheumatica developing after the use of immune checkpoint inhibitors to treat a variety of cancers. We found the article interesting and informative but noted that in all of their 10 reported cases, the patients seroconverted from rheumatoid factor (RF) or cyclic citrullinated peptide antibody (CCP) negative to positive, supporting their claim that ‘rheumatoid arthritis’ may develop after immune checkpoint inhibitor treatment. The report by Belkhir et al is in contrast to our experience managing …

Annals of the Rheumatic Diseases, 71(11), pp.1916-1917; 2012

Background Rheumatoid factor (RF) positivity that may occur in a number of patients with HBV infection poses challenges in terms of differential diagnosis with rheumatoid arthritis (RA). On the other hand, antibodies to cyclic citrullinated peptide (anti-CCP) may prove to be an important marker for differential diagnosis of the two conditions. Objectives This study aimed to assess anti-CCP and RF positivity among patients with hepatitis B and rheumatoid arthritis. Methods Anti-CCP and RF seropositivity was assessed in 61 patients with HBV infection (32 patients with chronic hepatitis, 29 patients with inactive HBV carrier status), and 40 patients with RA as the control group. Results RF positivity was found in 18.7% and 34.4% of the patients with chronic hepatitis B and inactive HBV carrier status, respectively. On the other hand, only one patient with chronic hepatitis B had low positive anti-CCP. RF was positive in 24 (60%) and anti-CCP was positive in 26 (65%) patients among the 40 patients with RA. Conclusions Anti-CCP may be helpful in the differential diagnosis between RA and chronic hepatitis B infection or inactive HBV carrier status. References Inanc N, Dalkilic E, Kamali S, et al. (2007) Anti-CCP antibodies in rheumatoid arthritis and psoriatic arthritis. Clin Rheumatol 26, 17-23. Lee SI, Yoo WH, Yun HJ, et al. (2007) Absence of antibody to cyclic citrullinated peptide in sera of non-arthritic patients with chronic hepatitis B virus infection. Clin Rheumatol 26, 1079-82. Lienesch D, Morris R, Metzger A, Debuys P, Sherman K (2005) Absence of cyclic citrullinated peptide antibody in nonarthritic patients with chronic hepatitis C infection. J Rheumatol 32, 489-93. Disclosure of Interest None Declared