Research article

Different properties of ACPA and IgM-RF derived from a large dataset: further evidence of two distinct autoantibody systems

Jennie Ursum¹ , Wouter H Bos¹ , Rob J van de Stadt¹ , Ben AC Dijkmans² and Dirkjan van Schaardenburg^1,2

¹  Jan van Breemen Institute, Dr. Jan van Breemenstraat 2, 1056 AB Amsterdam, The Netherlands

²  VU University Medical Centre, Postbus 7057, 1007 MB Amsterdam, The Netherlands

author email corresponding author email

Arthritis Research & Therapy 2009, 11:R75doi:10.1186/ar2704

Published:	21 May 2009

See related editorial by Valesini and Alessandri, http://arthritis-research.com/content/11/5/125

Abstract

Introduction

The aim of this study was to examine seroconversion and the relationship with age and inflammation of autoantibodies in a large group of patients attending an outpatient rheumatology clinic.

Methods

Levels of antibodies to citrullinated proteins/peptides (ACPAs) and IgM rheumatoid factor (IgM-RF) were determined in 22,427 samples collected from 18,658 patients. The diagnosis was derived from a diagnosis registration system. The degree of seroconversion in repeated samples and the correlation of levels with age and inflammatory markers were determined for ACPA and IgM-RF in rheumatoid arthritis (RA) and non-RA patients.

Results

Seventy-one percent of RA patients (n = 1,524) were ACPA-positive and 53% were IgM-RF-positive; in non-RA patients (n = 2,245), the corresponding values were 2% and 4%, respectively. In patients with at least two samples (n = 3,769), ACPA status was more stable than IgM-RF status in RA patients. ACPA- or IgM-RF-negative non-RA patients seldom became positive. ACPA positivity was unrelated to age in both RA and non-RA patients. IgM-RF positivity was unrelated to age in RA patients; however, it increased with age in non-RA patients. The correlation between autoantibody levels and inflammatory markers was low in general and was somewhat higher for IgM-RF than for ACPA.

Conclusions

ACPA status is more stable in time and with increasing age than IgM-RF status, further establishing its role as a disease-specific marker. ACPA and IgM-RF levels are only moderately correlated with markers of inflammation.