Anti-CCP-positive patients with RA have a higher 10-year probability of fracture evaluated by FRAX®: a registry study of RA with osteoporosis/fracture.
BACKGROUND
Positive anticyclic citrullinated peptide (anti-CCP+) is associated with bone loss in patients with rheumatoid arthritis (RA). However, whether overall positivity or specific levels of anti-CCP are associated with prevalent fracture or a 10-year probability of fracture remains unclear.


METHODS
This interim analysis of an RA registry was conducted at Chang Gung Memorial Hospital in Kaohsiung (CGMHK) for RA-related osteoporosis/fracture. Consecutive patients with RA who had visited the rheumatology clinic at CGMHK since September 1, 2014, and fulfilled the classification criteria of RA were enrolled. The demographics, disease duration, Disease activity in 28 joints based on erythrocyte sedimentation rate (DAS28-ESR), lifestyle, evidence of previous fracture, risk factors of fracture in the Fracture Risk Assessment Tool (FRAX®), and FRAX® score of each participant were collected. Anti-CCP, rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and bone mineral density (BMD) were measured at enrollment. The patients were grouped by positivity or quartiles of anti-CCP level (I-IV).


RESULTS
Five hundred twenty-one patients with RA were enrolled through May 31, 2016. In total, 359 (68.9%) patients were anti-CCP+. Compared with anti-CCP- patients, anti-CCP+ patients had a significantly higher DAS28-ESR (p = 0.0001) and 10-year probability of major (15.0 [18.9] vs. 12.0 [15.3], p = 0.0461) or hip (5.0 [9.2] vs. 3.6 [8.2], p = 0.0118) fracture, but a significantly lower BMD of the FN (p = 0.0196). The rates of osteoporosis and previous fracture were comparable. There were 130, 127, 132, and 132 patients in groups I-IV, respectively. The DAS28-ESR was significantly different (p = 0.0001) among the groups and correlated to anti-CCP levels. The BMD and 10-year probability of major (p = 0.0067) and hip (p = 0.0013) fracture among the groups were also different.


CONCLUSIONS
Anti-CCP+ RA patients had a higher 10-year probability of major or hip fracture, independent of anti-CCP levels, and a lower BMD of the FN than anti-CCP- patients.
['Cheng|Tien-Tsai|TT|0000-0002-8943-5056', 'Yu|Shan-Fu|SF|', 'Su|Fu-Mei|FM|', 'Chen|Yin-Chou|YC|', 'Su|Ben Yu-Jih|BY|', 'Chiu|Wen-Chan|WC|', 'Hsu|Chung-Yuan|CY|', 'Chen|Jia-Feng|JF|', 'Ko|Chi-Hua|CH|', 'Lai|Han-Ming|HM|']
D000328:Adult D000368:Aged D000075422:Anti-Citrullinated Protein Antibodies D001172:Arthritis, Rheumatoid D001799:Blood Sedimentation D015519:Bone Density D002097:C-Reactive Protein D005260:Female D050723:Fractures, Bone D006801:Humans D008297:Male D008875:Middle Aged D010024:Osteoporosis D011336:Probability D013997:Time Factors
FRAX Rheumatoid arthritis Anti-cyclic citrullinated peptide