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[EULAR文摘] 在总人群中监测ACPA能否预测早期关节炎

發布時間：2025/3/19 编程问答 26 豆豆

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標簽:?類風濕關節炎; 抗CCP抗體; 預測因子; 病程演變

在總人群中監測ACPA能否預測早期關節炎

Verstappen SM, et al. EULAR 2015. Present ID: OP0268.

背景：ACPA免疫應答常常先于RA診斷數年, 鮮有研究比較正常人群的ACPA與已發展為RA或炎性多關節炎(IP)人群中的ACPA。

目的：正常人群ACPA狀態與將來發展RA或炎性多關節炎(IP)人群的ACPA狀態進行比較。

方法：用ELISA方法檢測ACPA(歐洲Diagnostica公司)。基線時的血清樣本來自在英國諾福克進行的歐洲癌癥前瞻性調查研究(EPIC-Norfolk)隊列。此外, 資料包括ACPA狀態(>25U /mL為陽性)、年齡、性別、社會經濟地位(如手工/非技術熟練的工人, 經理/技術熟練的非體力勞動者, 專業人員)和吸煙狀況(從未吸煙、曾經和現在)。這個人群中若有發展為IP/RA的患者, 將通過諾福克關節炎注冊登記中心(NOAR, 英國一個基于初級保健的隊列)而被找到。用邏輯回歸分析評估總人群的人口統計特征是否與ACPA+的關聯, 校正年齡和性別后用Cox回歸分析評估ACPA與IP之間的關聯性。在EPIC-Norfolk隊列登記注冊時已經有關節炎癥狀的患者將不被納入本次Cox回歸分析(N= 104)。此外, 還分析了ACPA與吸煙之間的相互作用。隨訪患者直至出現以下任何一種情況, 他/她們發展為IP/RA, 或截尾至死亡或2014年5月。

結果：18628例EPIC參與者基線時檢測了ACPA, 年齡為40-79歲。EPIC人群中有429例(2.30％)ACPA陽性者。EPIC人群中有104例在注冊時已是IP/RA患者(35.6％ ACPA+, 滴度中位數6.95 [IQR: 3.75 -121.2])。在311051病人年隨訪過程中中, 173人發展為IP。

橫斷面分析顯示, 曾經吸煙和現在吸煙分別與ACPA+呈正相關(OR: 1.60, 95％CI: 1.95-2.13; OR: 1.29, 95％CI:1.02-1.55), 年齡與ACPA+相關(OR: 1.01, 95％CI: 1.00-1.03)。患者性別、社會地位與ACPA無關。上述173例在隨訪過程中發展為IP, 并在NOAR注冊登記, 其中85例(49.4％)符合2010年ACR/EULAR分類標準。基線ACPA檢測結果是發展為IP/RA的預測因素(校正HR: 10.3, 95%CI: 6.90-15.34)。ACPA與吸煙之間的交互作用不明顯。

結論：40至79歲的總人群樣本中ACPA陽性率為2.1％。ACPA陽性者在3至10年后發展為IP/ RA的可能性是ACPA陰性者的10倍。ACPA聯合其它檢查可有效地找到IP/RA高風險人群。

原文鏈接或參見以下信息。

Ann Rheum Dis?2015;74:173?doi:10.1136/annrheumdis-2015-eular.4793

Oral Presentations

OP0268?Anti-Citrullinated Protein Antibody (ACPA) Status in the General Population and as a Predictor of Future Inflammatory Polyarthritis: The EPIC-2-Noar Study

S.M. Verstappen¹,?

J.C. Sergeant²,?

R.N. Luben³,?

A. Bhaniani³,?

S. Anuj³,?

A. MacGregor⁴,

N. Wareham³,?

D.P. Symmons^1,2,?

K.T. Khaw³,?

I.N. Bruce^1,2?

on behalf of RA-MAP consortium

-Author Affiliations

¹Arthritis Research UK Centre for Epidemiology, The University of Manchester

²NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester

³European Prospective Investigation into Cancer and Nutrition,?Department of Public Health and Primary Care, Cambridge

⁴Norfolk and Norwich University Hospital, Norwich, United Kingdom

Abstract

? ? ? ? ? ?

Background?Anti-citrullinated protein antibody (ACPA) immune response occurs several years prior to the diagnosis of rheumatoid arthritis (RA). However, limited data are available on ACPA status in the general population compared to those who develop RA or inflammatory polyarthritis (IP) in the future.

Objectives?The aim of this study was to examine ACPA status in the general population and in patients developing IP/RA.

Methods?ACPA was measured by ELISA (Euro-Diagnostica) in stored serum samples collected at baseline in people participating in the European Prospective Investigation of Cancer in Norfolk, (EPIC-Norfolk), a prospective population-based study in the UK. In addition, data on ACPA status (positive >25 U/ml) age, gender, socio-economic status (i.e. manual/unskilled worker, manager/skilled non-manual worker, professional), smoking status (i.e. never, former, current) were also collected at inclusion. Individuals who subsequently developed IP/RA were identified by linkage with the Norfolk Arthritis Register (NOAR), a primary-care based cohort with an overlapping catchment area in the UK. Logistic regression analyses were used to assess the association between demographic characteristics and ACPA positivity in the general population. Cox regression analyses were performed to assess the association between ACPA and the development of IP, adjusting for age and gender. Patients with a symptom onset prior to inclusion in EPIC-Norfolk were excluded from the Cox regression analysis (N=104). In addition, the interaction between ACPA and smoking was tested. People were followed until development of IP/RA or censored at date of death or May 2014, whichever came first.

Results?ACPA was measured in 18,628 EPIC participants aged 40-79 years. ACPA was positive in 429 subjects (2.30%) of the whole EPIC population including 104 patients with prevalent IP/RA (35.6% ACPA positive, median titre 6.95 [IQR 3.75 – 121.2] U/ml) and 173 (16.8% ACPA positive, median titre 5.14 [IQR 3.37 – 9.41] U/ml) subjects who developed IP during 311,051 person years of follow-up. Cross-sectionally, current and former smokers (OR 1.60, 95%CI 1.95 to 2.13 and OR 1.29 95%CI 1.02 to 1.55, respectively) and older age (OR 1.01 95%CI 1.00 to 1.03) were associated with ACPA positivity. Gender and socio-economic status were not associated with ACPA. Of 173 patients who developed IP and were notified to NOAR, 85 (49.4%) fulfilled the 2010 ACR/EULAR criteria for RA at entry to the NOAR cohort. ACPA status was predictive for the development of IP/RA (adjHR 10,3 95%CI 6.90 to 15.34). The interaction between ACPA and smoking was not significant.

Conclusions?ACPA was positive in 2.1% of a general population sample aged 40-79 years old. People who were ACPA positive were 10 times more likely to develop IP/RA in the next 3-10 years than those ACPA negative subjects. ACPA may be a useful adjunct to other screening approaches to identify people at higher risk of developing IP/RA.

轉載于:https://www.cnblogs.com/T2T4RD/p/5464155.html

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