• Rotem Shpatz, Yolanda Braun-Moscovici, and Alexandra Balbir-Gurman.
• Shine Rheumatology Institute, Rambam Health Care Campus, Haifa, Israel.
• Isr Med Assoc J. 2021 Oct 1; 23 (10): 646-650.

BackgroundRheumatoid arthritis (RA) is a chronic inflammatory and destructive joint disease with the presence of autoantibodies, rheumatoid factor (RF), and anti-citrullinated protein antibodies (ACPA). The presence of RF or ACPA predicts RA severity. Data on the influence of ACPA titer on RA course are limited.ObjectivesTo determine the correlation between ACPA titers at the time of RA diagnosis to RA features and severity during 3 years of follow-up.MethodsWe performed a retrospective study of RA patients treated at our institution during the years 2006-2015 with known ACPA titers at RA diagnosis who completed at least 3 years of follow-up. Patients (N=133) were divided according to ACPA titer: seronegative (< 15 U/ml, n=55), weakly positive (15-49 U/ml, n=18), moderately positive (50-300 U/ml, n=29), and strongly positive (> 300 U/ml, n=31). Patient data, including disease activity score (DAS28), bone erosion on hand and/or foot X-rays, treatments with corticosteroids and disease-modifying-anti-rheumatic drugs (DMARDs), and hospitalizations, were recorded. Chi-square and Mann-Whitney method were used for statistical analysis. P < 0.05 was considered as statistically significant.ResultsMale gender, smoking, and RF positivity correlated with ACPA positivity and higher ACPA titers. There was no correlation between ACPA titer and the variables defined as representing RA severity: higher DAS28, bone erosions, hospitalizations, need for corticosteroids, and conventional and biological DMARDs.ConclusionsTiter of ACPA was not identified as a predictive factor for RA severity.

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