Article Text

  1. E. Mubashir,
  2. M. M. Ahmed,
  3. R. E. Wolf,
  4. S. Hayat,
  5. V. C. Hall,
  6. R. Shi,
  7. S. M. Berney
  1. Louisiana University Health Science Centers, Shreveport, LA


Background Several studies have detected that the level of IgM-RF decreases with effective disease modifying antirheumatic drugs (DMARDs), especially methotrexate and parental gold. In contrast, few studies have analyzed the variations in the titer of anticyclic citrullinated peptide (anti-CCP) antibody or rheumatoid factor (RF) during treatment with TNFa inhibitors.

Purpose To investigate the impact of infliximab treatment on anti-CCP antibody and RF levels in patients with rheumatoid arthritis (RA).

Methods Sera from 33 RA patients receiving infliximab plus other DMARDs were tested for anti-CCP antibody, IgA-, IgG-, and IgM-RF using a commercially available semi-quantitative ELISA at baseline and 30 and 54 weeks after treatment.

Results Patients had a mean age 6 SD of 54.6 6 12.1 years and a mean disease duration 6 SD of 12.9 6 8.3 years and were predominantly female (n = 28; 85%). At baseline, 27 of the 33 patients (81.8%) were positive for anti-CCP antibody, 28 (84.8%) for IgA-RF, 27 (81.8%) for IgG-RF, and 29 (87.8%) for IgM-RF. The proportion of patients who were positive for anti-CCP antibody (81.8% vs 78.5%), IgA-RF (84.8% vs 85.7%), IgG-RF (81.8% vs 85.7%), and IgM-RF (87.8% vs 89.2%) was similar at baseline and at 54 weeks. Serum levels of anti-CCP antibody and IgA-RF decreased significantly after 30 weeks; however, the decrease was not significant at week 54. The decrease in IgG-RF titers was not significant at 30 and 54 weeks. IgM-RF titers decreased significantly at 30 and 54 weeks. A strong correlation between anti-CCP and IgA-, IgG-, and IgM-RF was observed at baseline (Spearman's correlation coefficients (r) = .48, .43, .65, p = < .05) and after infliximab treatment at 30 weeks (r = .45, .46, .62, p = < .05) and 54 weeks (r = .49, .45, .60, p = < .05).

Conclusion Treatment with infliximab results in decreased anti-CCP antibody and IgA-RF early in the course of therapy that is not sustained. IgM-RF declines and remains decreased for at least 54 weeks. Investigations in larger cohorts of RA patients (especially early RA) with longer follow-up are needed to assess the impact of specific therapeutic interventions on anti-CCP antibody and RF levels and their relationship to disease activity.

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