Anti-cyclic citrullinated peptide antibody related to the disease progression and extra-articular involvement in patient with rheumatoid arthritis in Hospital Universiti Sains Malaysia

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BACKGROUND : \nRheumatoid arthritis (RA) is a chronic debilitating inflammatory disease affecting mainly the \njoint and surrounding tissue, and also involved other extra articular structures in the body. It \ncan lead to destruction of bone and cartilage which may cause severe disability to the patient. \nOther than rheumatoid factor, anti-cyclic citrullinate peptide (anti-CCP) antibody is another \nbiomarker that can be used to diagnose RA with higher sensitivity and specificity. \nOBJECTIVE : \nTo evaluate the significant of anti-CCP antibody in predicting the disease activity, and disease \nprogression in term of radiological and extra articular manifestation upon diagnosis in patient \nwith rheumatoid arthritis in HUSM. \nMETHODS : \nThis was a cross sectional study with retrospective record review. A total of 159 patients who \nwere diagnosed as rheumatoid arthritis based on 2010 EULAR criteria for RA since 2010 until \n2017 under rheumatology clinic HUSM follow up were included in this study. Exclusion \ncriteria include age of 16 years old or less at the onset of diagnosis, probable RA, and overlap \nsyndromes or related to other connective tissue disease. The data was retrieved from medical \nrecord for rheumatoid factor, anti-CCP antibody, assessment of disease activity using DAS28 \nESR calculator, plain radiograph of hands or feet, and extra-articular manifestation in term ofassessment of rheumatoid nodule, pulmonary involvement, Felty syndrome, vasculitis and \nanemia upon diagnosis. \nRESULTS : \nFrom a total of 159 patients, 134 (84.3%) patients were female with majority ethnic group was \nMalay (87.4%). The mean for age was 48.3 years old; ranging from 17 to 79. The prevalence \nof anti-CCP antibody was 52.2% (95% CI 0.44 to 0.60) and the percentage of positive \nrheumatoid factor was 62.3%. Mean DAS28-ESR score for total patients was 4.74 which \nmedium and high disease activity were predominant upon diagnosis. 36.5% of patients had \nradiological involvement and 30.8% of patients had extra-articular involvement manifested by \nrheumatoid nodule, pulmonary involvement, and anemia. \nPatients with both positive rheumatoid factor and anti-CCP antibody was significantly higher \nthan other groups (n=83; 73.5%) (p-value 0.002). For radiological involvement, it was \nsignificantly higher in anti-CCP antibody positive group. However, there was no significant \ndifference between mean and classes of disease activity score, and extra-articular \nmanifestations between different anti-CCP antibody positivity group. Extra-articular \nmanifestations was not associated with high disease activity upon diagnosis of RA. \nCONCLUSION : \nIn conclusion, there was significant association between anti-CCP antibody positivity and \npositive rheumatoid factor and radiological involvement, however no significant difference \nfound in mean disease activity and extra-articular manifestation upon diagnosis in patient withRA in HUSM. Extra-articular manifestations was not associated with high disease activity upon \ndiagnosis of RA.

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