摘要：目的：自身抗体检测有助于预测风险受试者进展为临床关节炎的风险。先前的纵向研究主要选择自身抗体阳性关节痛患者，从而进行自身抗体预测价值的相对评估。本研究根据临床特征（临床疑似关节痛，CSA）评估了由风湿病学家考虑为RA风险的关节痛患者中ACPA、RF和/或抗氨基甲酰化蛋白抗体（anti-CarP）阳性患者发展为关节炎的风险。

方法：研究了241例患者发展为临床关节炎的风险，CSA队列中纳入了基线ACPA、RF和抗CarP自身抗体，中位随访103周（四分位数间距为81-114）。

结果：观察的发展为关节炎风险的单因素变量ACPA、RF和抗CarP抗体：风险比（HR）（95％CI）分别为8.5（4.7-15.5）、5.1（2.8-9.3）和3.9（1.9-7.7）。在多变量分析中，仅ACPA与发展为关节炎风险独立相关（HR=5.1;2.0-13.2）。相对于自身抗体阴性的CSA患者，ACPA阴性/ RF阳性患者HR为2.6（1.04-6.6），ACPA阳性/RF阴性患者HR为8.0（2.4-27.4）和ACPA阳性/RF阳性患者HR为10.5（5.4-20.6）。2年内发展临床关节炎的阳性预测值分别为：38%的ACPA阴性/RF阳性，50％的ACPA阳性/RF阴性，67％的ACPA阳性/RF阳性患者。与高RF水平相反，高ACPA水平与临床关节炎的进展程度无显著相关性。随访期间自身抗体水平稳定。

结论：ACPA阳性患者发展为关节炎风险最高，对RF具有叠加效应。然而，在2年随访期间，大于30％的ACPA阳性/RF阳性CSA患者并未发展为关节炎。因此，CSA和自身抗体不足以准确识别即将发展为自身抗体阳性RA。

附原文：

AbstractOBJECTIVES:Autoantibodytesting is helpful for predicting the risk of progression to clinicalarthritisin subjects at risk. Previouslongitudinal studies have mainly selected autoantibody-positive arthralgiapatients, and consequently the predictive values of autoantibodies wereevaluated relative to one another. This study assessed the risks forarthritisdevelopment of ACPA, RF and/oranti-carbamylated protein antibodies (anti-CarP) in arthralgia patientsconsidered at risk for RA by rheumatologists, based on clinical characteristics(clinically suspect arthralgia, CSA).

METHODS:Thebaseline ACPA, RF and anti-CarP autoantibody status of 241 patients,consecutively included in the CSA cohort, was studied for risk of developingclinicalarthritisduring a median follow-up of 103 (interquartilerange: 81-114) weeks.

RESULTS:Univariableassociations forarthritisdevelopmentwere observed for ACPA, RF and anti-CarP antibodies; hazard ratios (HRs) (95%CI) were 8.5 (4.7-15.5), 5.1 (2.8-9.3) and 3.9 (1.9-7.7), respectively. Inmultivariable analysis, only ACPA was independently associated (HR = 5.1;2.0-13.2). Relative to autoantibody-negative CSA patients,ACPA-negative/RF-positive patients had HRs of 2.6 (1.04-6.6), ACPA-positive/RF-negativepatients 8.0 (2.4-27.4) and ACPA-positive/RF-positive patients 10.5 (5.4-20.6).Positive predictive values for development of clinicalarthritiswithin 2 years were: 38% forACPA-negative/RF-positive, 50% for ACPA-positive/RF-negative and 67% forACPA-positive/RF-positive patients. Higher ACPA levels were not significantlyassociated with increased progression to clinicalarthritis,in contrast to higher RF levels. Autoantibody levels were stable duringfollow-up.

CONCLUSION:ACPAconferred the highest risk forarthritisdevelopmentand had an additive value to RF. However, >30% of ACPA-positive/RF-positiveCSA patients did not developarthritisduringthe 2-year follow-up. Thus, CSA and information on autoantibodies isinsufficient for accurately identifying imminent autoantibody-positive RA.

引自：Ten Brinck RM,van SteenbergenHW,van Delft MAM,et al.

The risk of individualautoantibodies, autoantibody combinations and levels for arthritisdevelopmentin clinically suspect arthralgia

Rheumatology(Oxford).2017 Sep 11.

doi:10.1093/rheumatology/kex340.