Next-generation rheumatoid factor assay provides improved predictive power for the development of arthritis in patients at risk.

IF 5.1 2区 医学 Q1 RHEUMATOLOGY
Nienke Oskam, Pleuni Ooijevaar-de Heer, Dorien Kos, Laurette van Boheemen, Dirkjan van Schaardenburg, Gertjan Wolbink, Theo Rispens
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Abstract

Objective: Rheumatoid arthritis (RA) is characterised by the presence of autoantibodies, among which those targeting the constant region of immunoglobulin G (IgG), called rheumatoid factors (RF). Despite this link, RFs can also be found in other disorders and the healthy population, which hampers its use as a diagnostic tool. We recently showed that a subset of RA-derived RFs target a distinct epitope on the IgG-Fc, a feature that is currently not used in the clinic.

Methods: We determined immunoglobulin M (IgM)-RF levels specific against an RA-associated epitope (using our engineered next-generation RF antigen 'T3-17') in a prospective cohort of 475 patients with seropositive (for IgM-RF or aCCP) arthralgia that were followed for 5 years or until the development of arthritis.

Results: The presence of RFs targeting T3-17 was more strongly associated with progression to arthritis in comparison to traditional RF measurements. Within the group of patients positive for T3-17 RF the risk of arthritis development was increased as compared with wild-type RF, HR=3.2 (95% CI 2.4 to 4.3) vs HR=2.2 (95% CI 1.7 to 3.0). Predictive power of T3-17 RF was improved in combination with aCCP titres, HR=6.4 (4.7-8.7) vs HR=5.1 (3.9-6.8). This combination performed better than aCCP detection on its own.

Conclusion: The detection of disease-specific RF is feasible and seems to improve the diagnostic power of RF and should be considered to be implemented in the clinic.

新一代类风湿因子测定提高了对高危患者发生关节炎的预测能力。
目的:类风湿性关节炎(RA)的特征是存在自身抗体,其中针对免疫球蛋白 G(IgG)恒定区的抗体被称为类风湿因子(RF)。尽管存在这种联系,但在其他疾病和健康人群中也可发现类风湿因子,这就妨碍了类风湿因子作为诊断工具的使用。我们最近发现,RA 衍生的 RFs 中有一部分靶向 IgG-Fc 上的一个独特表位,而这一特征目前尚未用于临床:方法:我们对 475 例血清反应阳性(IgM-RF 或 aCCP)的关节痛患者进行了前瞻性队列研究,测定了针对 RA 相关表位的特异性免疫球蛋白 M(IgM)-RF 水平(使用我们设计的新一代 RF 抗原'T3-17'),并对这些患者进行了为期 5 年的随访,直至出现关节炎:结果:与传统的射频测量相比,以 T3-17 为靶点的射频的存在与关节炎的进展关系更为密切。与野生型射频相比,在T3-17射频阳性的患者组中,关节炎发展的风险增加,HR=3.2(95% CI 2.4-4.3) vs HR=2.2(95% CI 1.7-3.0)。结合 aCCP 滴度,T3-17 RF 的预测能力有所提高,HR=6.4(4.7-8.7) vs HR=5.1(3.9-6.8)。这一组合比单独检测 aCCP 效果更好:结论:检测疾病特异性射频是可行的,而且似乎提高了射频的诊断能力,应考虑在临床中实施。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
RMD Open
RMD Open RHEUMATOLOGY-
CiteScore
7.30
自引率
6.50%
发文量
205
审稿时长
14 weeks
期刊介绍: RMD Open publishes high quality peer-reviewed original research covering the full spectrum of musculoskeletal disorders, rheumatism and connective tissue diseases, including osteoporosis, spine and rehabilitation. Clinical and epidemiological research, basic and translational medicine, interesting clinical cases, and smaller studies that add to the literature are all considered.
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