Anti CCP antibodies and the treatment of RA with only a few joints affected

 

Question  I was diagnosed with RA about 3 years ago. My diagnosis was based on positive anti-CCP and RF (out of range). I had about 2 tender joints at diagnosis. I had no morning stiffness; ESR and CRP were normal (and still normal); and ANA negative. I am taking MTX (10 mg qw). Do I really have RA? Thank you, Kala
 
Answer  Kala, this is a very good question and one that we are dealing with more and more these days. The anti CCP antibody is to date our most SPECIFIC marker for the disease of rheumatoid arthritis, with a specificity of > 99%.  We now understand that this test can become positive years before the first signs of rheumatoid arthritis joint swelling.  While not detected in all patients with RA, when the CCP antibody is present, we know that this test also indicates patients at higher risk of joint damage.  Based on the results of several studies in patients with very early RA with only a few swollen and tender joints who have a positive anti-CCP antibody, we have seen that initiation of methotrexate can decrease the numbers of patients that go on to be classified as rheumatoid arthritis and also decreases XRay damage. Others have used hydroxychloroquine (Plaquenil). I hope at this point that your arthritis is under control.  We usually will continue to monitor X-Rays of the joints every year or so.  In patients who have had an initial and sustained response (eg "remission" of their arthritis) on medication, we may then consider tapering back medications. Sometimes this is possible, but in our experience, more often than not, the disease begins to come back.  Through research we hope to better understand the early triggers of the disease, the biomarkers that may help to determine the best drugs, and ultimately a true "cure" for RA.   

Last update: 10:58 AM Wednesday, December 31, 2008

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Author:

Clifton Bingham, III, MD

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